Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442 - 44 32 Corporate Online Services Information: Many corporate filings are available by using CorpOnline Service. Go to CorpOnline site at https://corp online .dcra.dc.gov , create the profile, access the online services main page and proceed. Online filers must pay by using the credit card . District of Columbia Government Corporations Division Surrender of Charter Upon Domestication of Domestic For - Profit Corporation Form DBU - 4 , Ver. 2 , April 2018 . This form will allow for a domestic for - profit corporation to surrender its charter while domesticating to another jurisdiction. ENTITY TYPE FILING F E E Refer to Corporate Fee Schedule posted online; Under the provisions of the Title 29 of D.C. Code (Business Organizations Act), the domestic filing entity listed below hereby applies for a Certificate of Surrender of Charter and for that purpose submits the statement below. 1. Corporation Name. 2. The articles of charter surrender are being filed in connection with the domestication of the corporation in a foreign jurisdiction . 3.The domestication was duly approved by the shareholders and, if voting by any separate voting group was required, by ea ch such separate voting group, in the manner required by 247 29 - 307.04 and the articles of incorporation. 4.The corporation's new jurisdiction of incorporation. If you sign this form you agree that anyone who makes a false statement can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC 247 22 - 2405; 5 .Name of the Governor or Authorized Person. 6 .Signature of the Governor or Authorized Person. American LegalNet, Inc. www.FormsWorkFlow.com