Delaware Division of Corporations 401 Federal Street – Suite 4 Dover, DE 19901 Ph: 302-739-3073 Fax: 302-739-3812 Certificate of Dissolution Short Form for Non-Stock Corporation Dear Sir or Madam: Attached please find a copy of the Certificate of Dissolution to be filed in accordance with Section 276 (a) and 391 (a) (5) (b) of the General Corporation Law of the State of Delaware. The fee to file the Certificate is $10.00. You will receive a stamped “Filed” copy of your submitted document. A certified copy maybe requested for an additional $50. Expedited services are available. Please contact our office concerning these fees or you may consult our fee chart at www.corp.delaware.gov. Before the Certificate can be filed, all applicable Annual Franchise Tax Reports must be filed. Please contact the Franchise Tax Section prior to submitting the document for filing to determine the Annual Reports due. Please make your check payable to “Delaware Secretary of State”. For the convenience of processing your order in a timely manner, please include a cover letter with your name, address and telephone/fax number to enable us to contact you if necessary. Please make sure you thoroughly complete all information requested on this form. It is important that the execution be legible, we request that you print or type your name under the signature line. Thank you for choosing Delaware as your corporate home. Should you require further assistance in this or any other matter, please don’t hesitate to call us at (302) 7393073. Sincerely, Department of State Division of Corporations rev. 08/10 American LegalNet, Inc. www.FormsWorkFlow.com Special Instructions – Short Form Certificate of Dissolution of Non-Stock Corporation This form is to be used as a Template only. The following instructions will help you in correctly completing your Dissolution Certificate. The instructions will be numbered to correspond with the article it is referencing. 1. The current name of the corporation exactly as it appears in our records. Please visit our website to verify the name. 2. The date when the corporation was originally formed. 3. List the date the Dissolution was authorized by the Governing Body of the Corporation. 4. List the names and addresses of all directors and officers of the corporation. Please list complete addresses which include street, number, city and zip code. Execution Block - The document must be signed by an authorized officer of the corporation pursuant to Section 103 of Title 8. The name of the person must be typed or written legibly underneath the signature. This form contains information required by statute; if you need to add additional information permitted by statute you may draft a new document. Please feel free to call our office at 302-739-3073 for assistance in completing this form. Sincerely, Delaware Division of Corporations American LegalNet, Inc. www.FormsWorkFlow.com STATE OF DELAWARE SHORT FORM CERTIFICATE OF DISSOLUTION OF NON-STOCK CORPORATION (SECTIONS 276 (a) and 391 (a) (5) (b)) The corporation organized and existing under the General Corporation Law of the State of Delaware, hereby certifies as follows: 1. The dissolution of has been duly authorized in accordance with the provisions of Section 276(a) of the General Corporation Law of the State of Delaware. 2. The date of filing of the Corporation’s original Certificate of Incorporation in Delaware was 3. . The date the dissolution was authorized is 4. The names and addresses of the directors and officers of the corporation are as follows: NAME 5. TITLE ADDRESS The corporation has no assets and has ceased transacting business. 6. The corporation, for each year since its incorporation in this State, has not been required to pay franchise tax prescribed by Section 503 of the General Corporation Law of the State of Delaware 7. The corporation has paid all fees due to or assessable by this State through the end of the year in which the certificate of dissolution is filed. By: Authorized Officer Name: Print or Type American LegalNet, Inc. www.FormsWorkFlow.com