Version 1; 04-06-09 District of Columbia Government Corporations Division PO Box 92300 Washington DC 20090 Application and Petition for Reinstatement for Domestic For-Profit Corporation Use this form to reinstate a domestic business corporation in the District of Columbia. ENTITY TYPE FILING FEE Domestic For-Profit Corporation $250, payable to DC Treasurer Pursuant to the provisions of Title 29, Chapters 1 & 4 of the Code of Laws of the District of Columbia, the undersigned domestic for-profit corporation hereby petitions and applies for a Certificate of Reinstatement of a proclaimed domestic for-profit corporation and hereby certifies as follows: 1. Entity Name at the time of proclamation: 2. New name that the corporation will be known as from now on. (If the Corporation name is available, you must use that name; if the name has been taken by another corporation, then you may choose a different name.) 3. The Certificate of Incorporation to transact business in the District of Columbia was revoked on September for failure and/or refusal to file reports for the reporting period or other reasons under DC Official Code (DCOC). (Revocation dates are always the 2nd Monday of September of the year of revocation. 4a. Registered Agent in the District of Columbia at the time of proclamation: 4b. That Registered Agent's address: 5. Attach any DCOC-required delinquent reports and filing fees and penalties. President / Vice-President Date Signature Secretary / Assistant Secretary Date Signature If you sign this application, you agree that you understand that anyone who makes a false statement anywhere on it can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405. Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442-4400 For overnight delivery send to: Corporate Bank of America Attention: DC Government Wholesale Lockbox #92300 Mail Code MD4-301-18-04 225 North Calvert Street - 18th floor Baltimore, Maryland 21202 Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Just click on "Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com