Version 1; 04-06-09 District of Columbia Government Corporations Division PO Box 92300 Washington DC 20090 Statement of Intent to Dissolve by Written Consent of Shareholders Use this form to file statement of intent to dissolve for a domestic business corporation in the District of Columbia. NOTE: This form must be filed before or along with submitting "Articles of Dissolution" form on page 2. ENTITY TYPE FILING FEE Domestic For-Profit Corporation $35, payable to DC Treasurer Pursuant to the provisions to Title 29, Chapter 1 of the Code if Laws of the District of Columbia, the undersigned corporation submits the following statement of intent to dissolve the corporation upon written consent of the holders of record of all of its outstanding shares: 1. Entity Name: 2. The name and address of its officers: NAME & TITLE ADDRESS 3. The name and address of its directors: NAME ADDRESS 4. By signing this form you agree to the following: • The written consent to dissolution of the corporation has been signed by all the shareholders of record of the corporation, or signed in their names by their respective attorneys hereunto duly authorized. • A copy of the agreement signed by all shareholders of record of the corporation consenting to its dissolution is attached. President / Vice-President 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