Commonwealth of Kentucky ALISON LUNDERGAN GRIMES, SECRETARY OF STATE _________________________________________________________________________________________________________________________ Division of Business Filings Business Filings PO Box 718 Frankfort, KY 40602 (502) 564-3490 www.sos.ky.gov Articles of Dissolution (Profit Corporation) This form is to be used for dissolution by the Board of Directors or Shareholders. DIS Please note: Filing this form with the Office of the Secretary of State does not ensure the dissolution of the business entity is complete. Filers are encouraged to seek the advice of a professional prior to filing Articles of Dissolution. Pursuant to the provisions of KRS 14A and KRS 271B.14-030, the corporation listed below adopts the following articles of dissolution: Article I: The name of the profit corporation of record with the Office of the Secretary of State: ________________________________________________________________________________________________ (The name must be identical to the name on record with the Secretary of State.) Article II: The dissolution was authorized on _____________________________________________________________ Article III: The dissolution was approved by: (check only one) ____shareholder(s) or ____board of directors as outlined in 271B.14-030. Article IV: If the dissolution was approved by the shareholders, the voting information is listed below: a) and b) c) or d) e) The total number of undisputed votes cast for dissolution._________. The number cast for dissolution was sufficient for approval. The number of votes cast for the dissolution ___________________. The number of votes cast against the dissolution________________. Number of votes entitled to be cast on proposal to dissolve ________. Article V: If the dissolution was approved by voting group(s) the voting information is listed below: a) and b) c) or d) e) The total number of undisputed votes cast for dissolution._________. The number cast for dissolution was sufficient for approval.. The number of votes cast for the dissolution ___________________. The number of votes cast against the dissolution________________. Number of votes entitled to be cast on proposal to dissolve ________. Article VI: This application will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date or the delayed effective date cannot be prior to the date the application is filed. The date and/or time is ___________________________. (Delayed effective date and/or time) I declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct. (12/12) American LegalNet, Inc. www.FormsWorkFlow.com _________________________________________________ _____________________________ _____________________ _______ Signature of Officer and Chairman of the Board Printed Name Title Date FILING INSTRUCTIONS ARTICLES OF DISSOLUTION NAME The profit corporation name provided on the articles of dissolution must read exactly as stated in the most recent articles. This can be found using the organization search tool located on the Secretary of State website at www.sos.ky.gov. WHO MAY SIGN The articles of dissolution must be signed by an officer or the chairman of the board. PRINCIPAL OFFICE ADDRESS The principal office is the office (in or out of this state) so designated in writing with the Office of the Secretary of State where the principal designated office of the business entity is located. This address is where all correspondence from the Office of the Secretary of State (See Document Delivery) will be mailed. EFFECTIVE DATE AND TIME The document will be effective on the date and time of filing, unless a delayed effective date and/or time is specified. The effective date or the delayed effective date cannot be prior to the date the application is filed. A delayed effective date may not be later than the 90th day after the date of filing. ADDITIONAL ARTICLES OF DISSOLUTION OR NEED TO MODIFY THE EXISTING FORM If this form does not comply with the articles of dissolution that you wish to file please disregard this form, please send a drafted executed copy of the articles of dissolution according to KRS 271B.14 to the address below. DOCUMENT DELIVERY A file stamped postcard will be sent to the principal office address. If the applicant wishes for the document to be sent to an alternate address other than the principal office, a request must be submitted in writing affirming that request. Alternate address requests must be submitted with each document filed with the Office of the Secretary of State. NUMBER OF COPIES Submit the original signed articles of dissolution as well as three (3) exact or conformed copies. One (1) of the exact or conformed copy of the articles of dissolution will be sent to the secretary of revenue. FILING FEE The filing fee for Articles of Dissolution is $40.00. Your check should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS Alison Lundergan Grimes Secretary of State P. O. Box 718 Frankfort, KY 40602-0718 OFFICE LOCATION Room 154, Capitol Building 700 Capital Avenue Frankfort, KY 40601 Hours of Operation: 8:00 AM-4:30 PM ET CONTACT INFORMATION If you have any questions or need additional forms, please feel free to visit our website at www.sos.ky.gov or call (502) 564-3490. (12/12) American LegalNet, Inc. www.FormsWorkFlow.com