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Ss. 178.43 (2m), 179.045, 180.0503, 180.1509, 181.0503, 181.1509, 183.0105 (5) & 183.1009, Wis. Stats.

State of Wisconsin DEPARTMENT OF FINANCIAL INSTITUTIONS Division of Corporate & Consumer Services

RESIGNATION OF REGISTERED AGENT
1. The undersigned resigns as registered agent for a limited liability partnership, limited partnership, corporation or limited liability company ("entity") organized under the laws of .

2. Said entity has its present registered office in Wisconsin at

and said registered office is discontinued. 3. Said entity has its present principal office at (complete mailing address):

4. Executed on (Date) By an Individual BY: Registered Agent (Signature) By an Entity FOR THE REGISTERED AGENT BY: (Signature) (Printed Name of the Registered Agent)

FILING FEE - $10.00 See instructions on the following page. DFI/CORP/13-R(R02/10/03) Use of this form is voluntary.

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RESIGNATION OF REGISTERED AGENT

Your return address and phone number during the day: ( ) _______ - _______________

INSTRUCTIONS: (Ref. Ss. 178.43 (2m), 179.045, 180.0503, 180.1509, 181.0503, 181.1509, 183.0105 (5) and 183.1009 Wis. Stats., for document content) Submit one original and two exact copies to Department of Financial Institutions, P O Box 7846, Madison WI, 53707-7846, together with a filing fee of $10.00, payable to the department. Filing fee is non-refundable. (If sent by Express or Priority U.S. mail, address to 345 W. Washington Ave, 3rd Floor, Madison WI, 53703.) Sign the document manually or otherwise as allowed under sec. 178.46 (1g) (d) and similar sections. NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made with the department. Information requested may be used for secondary purposes. If you have any questions, please contact the Division of Corporate & Consumer Services at 608-261-7577. Hearing-impaired may call 608-266-8818 for TTY. This document can be made available in alternate formats upon request to qualifying individuals with disabilities. (Note: This form is suitable for use by a domestic or foreign limited liability partnership, limited partnership, corporation, or limited liability company organized or licensed under Chs. 178, 179, 180, 181 or 183 of the Wisconsin Statutes, respectively.) 1. 2. 3. 4. Enter the name and state of organization of the entity for which the registered agent is resigning. If the entity is licensed in this state under a fictitious name, list the fictitious name. Enter the address of the entity's present registered office in Wisconsin. Enter the address of the entity's present principal office, whether located in Wisconsin or elsewhere. Enter the date of execution and the printed name of the Registered Agent. Sign the statement, using the appropriate signature area. One signature area is provided for execution of the statement by an individual and another signature area for execution by an entity, such as a corporation.

DFI/CORP/13-RI(R02/10/03)

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