Secretary of State AFFIDAVIT TO DISSOLVE CORPORATION (R.S. 12:250.1)Return to: Commercial Division P.O. Box 94125Baton Rouge, LA 70804-9125 (225) 925-4704www.sos.la.gov Domestic Non Profit CorporationEnclose $75 filing feeMake remittance payable toSecretary of StateDo Not Send Cash STATE OFPARISH/COUNTY OFBEFORE ME, the undersigned Notary Public in and for the parish/county herein above shown, personally cameand appeared the undersigned who, after being duly sworn, did depose and say that:Corporation Nameis no longer doing business and owes no debts is dissolved by filing this affidavit with the Secretary of State, executed by the shareholder(s), or incorporator(s) attesting to such facts. such facts.The undersigned further declared that they are: (check one)( )The shareholders of the above named corporation.( )The incorporators of the above named corporation and no shares have been issued.Incorporator(s) or Shareholder(s) Signature(s)Sworn to and subscribed before me, the undersigned Notary Public, on this date:Notary Signature, Printed name and Notary/Bar Roll # SS339 Rev. 0 (See instructions on back) American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS File this form, along with the appropriate filing fee with the Secretary of State222s office.You will receive a Certificate of Dissolution, a copy of which should be filedwith the lerk of ourt where the corporation maintains its registered office. If thecorporation222s registered office is located in Orleans Parish, a Certificate of Dissolutionmust be filed with the recorder of mortgages. American LegalNet, Inc. www.FormsWorkFlow.com