Amendment/Withdrawal - Foreign Limited Liability Company 
               Secretary of State - Corporation Division - 255 Capitol St. NE, Suite 151 - Salem, OR 97310-1327 – sos.oregon.gov/business - Phone: (503) 986-2200 
               Check the appropriate box below: 
                   AMENDMENT TO APPLICATION FOR AUTHORITY                                                                                                     Print Form
               (Complete only 1, 2, 3, 9) 
                   WITHDRAWAL OF AUTHORITY TO TRANSACT BUSINESS                                                                                               Reset Form
               (Complete only 1, 4, 5, 6, 7, 8, 9) 

REGISTRY NUMBER: 

In accordance with Oregon Revised Statute 192.410-192.490, the information on this application is public record. 
W e must release this information to all parties upon request and it will be posted on our website.                                                           For office use only 
Please Type or Print Legibly in Black Ink.  Attach Additional Sheet if Necessary. 
1) NAME: (Must contain the words “Limited Liability Company” or the abbreviations “LLC” or “L.L.C.”)

        AMENDMENTTO APPLICATION FOR             AUTHORITYONLY                                                         WITHDRAWAL OFAUTHORITYONLY
2) INITIAL REGISTRATION  ATED   OF  PPLICATIONA         :                         4)                STATE OR COUNTRY OF  RGANIZATIONO            :

                                                                                  5)                SURRENDER OF AUTHORITY  :
3) AMENDMENT: (The amendment to the application for registration of foreign 
   Limited Liability Company is as follows.)                                                         This foreign limited liability company is not transacting business in Oregon, and 
                                                                                                     surrenders its authority to transact business in Oregon. 
                                                                                  6)                REVOCATION OF AGENT S ’UTHORITY             :                                                 A 
                                                                                                     This foreign limited liability company revokes the authority of its registered agent to 
                                                                                                     accept service on its behalf and appoints the Secretary of State as its agent for service of 
                                                                                                     process in any proceeding based on a cause of action arising during the time it was 
                                                                                                     authorized to transact business in Oregon. 

                                                                                  7)                MAILING ADDRESS   : (Address to which the person initiating any proceeding may mail to 
                                                                                                    this corporation a copy of any process served on the Secretary of State.) 

                                                                                  8)                NOTIFICATION:
                                                                                                     The foreign Limited Liability Company will notify the Corporation Division, Business 
                                                                                                     Registry of any change in this mailing address for a period of five years from the date of 
                                                                                                     this withdrawal. 

9) EXECUTION: (At least one member or manager must sign.)
   I declare as an authorized signer, under penalty of perjury, that this document does not fraudulently conceal, fraudulently obscure,
   fraudulently alter or otherwise misrepresent the identity of the person or any members, managers, employees or agents of the limited
   liability comp any. This filing has been examined by me and is, to the best of my knowledge and belief true, correct, and complete.
   Making false statements in this document is against the law and may be penalized by fines, imprisonment or both.
   Signature:                                                               Printed Name:                                             Title:

CONTACT NAME  :(To resolve questions with this filing.)                           FEES 
                                                                                     Required Processing Fee           $275 
PHONE NUMBER  :(Include area code.)                                               ProcessingFees are nonrefundable.    Please make check payable to           “CorporationDivision.” 
                                                                                  Free copies are available at sos.oregon.gov/business, using the Business Name Search program. 

 111 - Amendment W ithdrawal - Foreign Limited Liability Company (11/17)