F0022 - Page 1 of 2 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1333 Application for Reinstatement *0022-1-2* Following Administrative Dissolution/Revocation This application is submitted to the Office of Secretary of State of Mississippi for Reinstatement. 1. Name of Corporation 2. Federal Tax ID number 3. Corporate ID number 4. Date of Administrative Dissolution/Revocation 5. The grounds for Dissolution/Revocation did not exist or have been eliminated. (Complete and mark appropriate box) 6. The corporate name satisfies the requirements of the Mississippi Business Corporation Act. Note: Certification from the Mississippi State Tax Commission stating that all taxes owed by the corporation have been paid must accompany this application. This application must be executed in the name of the corporation by the chairman of the board of directors, the president or another of the officers. (Please keep writing within blocks) By: Signature Printed Name Title Date Filing Fee $50.00 for Domestic Corporations Filing Fee $100.00 for Foreign Corporations Rev. 01/96 >>>> 2 F0022 - Page 2 of 2 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1333 Request for Certification *0022-2-2* 1. Name of Corporation 2. Street Address City, State, ZIP5, ZIP4 - 3. Incorporated in the State of 4. Federal Tax ID Number This is to request certification from the Mississippi State Tax Commission that all taxes owed by this corporation have been paid. Name of Corporation (Please keep writing within blocks) By: Signature Printed Name Title Please send this form directly to: MISSISSIPPI STATE TAX COMMISSION PO BOX 1033 JACKSON, MS 39215