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Amendment/Withdrawal--Foreign Limited Liability Company (Oregon)

This is to amend or withdraw a foreign limited liability company in Oregon. The form provided here is simply a sample of what the actual Form CR158 looks like.

CR158

Phone: (503) 986-2200
Fax: (503) 378-4381
Secretary of State
Corporation Division
255 Capitol St. NE, Suite 151
Salem, OR 97310-1327

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For office use only

Registry Number: ________________________________

Check the appropriate box below:

____ AMENDMENT TO APPLICATION FOR AUTHORITY (Complete only 1, 2, 3, 9, 10)

____ WITHDRAWAL OF AUTHORITY TO TRANSACT BUSINESS (Complete only 1, 4, 5, 6, 7, 8, 9, 10)

Attach Additional Sheet if Necessary
Please Type or Print Legibly in Black Ink

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Amendment/Withdrawal--Foreign Limited Liability Company

Amendment to Application Only

1) Name (Must contain the words "Limited Liability Company" or the abbreviations "LLC" or "L.L.C."

___________________________________

AMENDMENT TO APPLICATION FOR AUTHORITY ONLY

2) Initial Registration Date of Application ________________________

3) Amendment (The amendment to the application for registration of foreign limited liability company is as follows. Only the company name or duration can be amended. Attach a separate sheet if necessary.)

___________________________________

___________________________________

___________________________________

Withdrawal of Authority Only

4) State or Country of Organization ___________________________________

5) Surrender of Authority

____ 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 Authority

____ This foreign limited liability company revokes the authority of its register 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 (The address to which the person initiating any proceeding may mail to this Corporation a copy of any process served on the Secretary of State.)

Address ____________________________________

City ____________________________________

State ____________________________________

Zip ____________________________________

9) Execution

Printed Name ____________________________________

Signature ____________________________________

Title ____________________________________

10) Contact Name ____________________________________

Daytime Phone Number--Including Area Code ________________________


FEES

Please make check for $10 payable to "Corporation Division."

NOTE: Filing fees may be paid with VISA or MasterCard. The card number and expiration date should be submitted on a separate sheet for your protection.

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