Withdrawal of Trade Name Report

FILING FEE: $25.00 PRINT CLEARLY WITHDRAWAL OF TRADE NAME REPORT TO: OKLAHOMA SECRETARY OF STATE 2300 N. Lincoln Blvd., Room 101, State Capitol Building Oklahoma City, Oklahoma 73105-4897 (405) 521-3912 The undersigned "business entity" hereby submits the following withdrawal of trade name report pursuant to Title 18, Oklahoma statutes, Section 1140.1: 1. The legal name of the "Business Entity" is: 2. The type of "Business Entity" is: (Please Note: "BUSINESS ENTITY" means a corporation, a business trust, a common law trust, a limited liability company, or any unincorporated business, including any form of partnership.) 3. The business entity was formed in the State/Country of: 4. The business entity is no longer doing business in the state of Oklahoma under the following trade name: I/we, being duly authorized to sign on behalf of the above named business entity, do hereby execute this report on the day of , . Signature Signature (List title if applicable ) (List title if applicable ) (Type or Print Name) (Type or Print Name) (SOS FORM 0040-12/01)