STATE OF DELAWARE

SHORT FORM CERTIFICATE OF

DISSOLUTION

PURSUANT TO SECTION 275

 

FIRST:  The name of the corporation is ___________________________.

 

SECOND: The corporation has no assets and has ceased transacting business.

 

THIRD: The Corporation, for each year since its incorporation in this State, has been required to pay only the minimum franchise tax then prescribed by Section 503 of the General Corporation Law of the State of Delaware.

 

FOURTH: The Corporation has paid all franchise taxes and fees due to or assessable by this State, per section 391, through the end of the year in which the certificate of dissolution is filed.

 

FIFTH:  The dissolution has been authorized by the board of directors and stockholders or by unanimous consent of stockholders on ___________________, 20___.

 

SIXTH:  The names and addresses of the directors and officers of the corporation are as follows:

NAME                                     TITLE                          ADDRESS

 

 

SEVENTH:  The signatory hereto acknowledges the above statements to be true.

 

                                    BY:                  _____________________________

 

                                    NAME:            _____________________________

 

                                    TITLE: _____________________________

 

IN WITNESS WHEREOF, the Board of Directors has caused this certificate to be signed by _________________________, an Authorized Officer, this ________ day of _________________, AD 20___.

 

SIGNED: ________________________________

 

NAME: __________________________________

 

TITLE: __________________________________