C-159A Rev. 7/03 State of New Jersey CERTIFICATE OF DISSOLUTION (Before Commencing Business) (For Use by Domestic Profit and Non-Profit Corporations) (Non-Profit Corporations Must File This Form in Triplicate) Check Appropriate Statute: __ 14A:12-2 New Jersey Business Corporation Act (File in Duplicate) __ 15A:12-2 New Jersey Nonprofit Corporation Act (File in Triplicate) 1. Name of Corporation: 2. Business Entity Number: 3. Registered Agent: 4. Registered Office: (Street and postal designation) (City) (State) (Zip) 5. Set forth the names and addresses of the Incorporators and Directors/Trustees constituting the First Board. NOTE: Address cannot be t hat of the corporation. Said corporation has not commenced business/activity and has issued no shares, and has no debts or other liabilities. Note: Nonprofit Corporations that have assets must adopt and atta ch a "Plan of Dissolution" pursuant to N.J.S.A. 15A: 2-8. Said corporation has received no payments or subscriptions to its shares, or, if it has received such payments, that it has returned them to those entitled thereto, less any part thereof disbursed for expenses; and That the sole Incorporator or Director, if there is only one, or both Incorporators or Directors, if there are only two, or a majority of the Incorporators or Directors/Trustees, if there are more than two, has or have elected that the corporation be dissolved. The undersigned petitions the Treasurer, State of New Jersey to accept for f iling this Certificate of Dissolution pursuant to the provisions provided, without payment of any filing fee and the payment, or provision for the payment, by the corporation of taxes, fees, penalties, and interest. The name of the corporation shall be available immediately for corporate use upon the filing of this Certificate of Dissolution. Signature: Date: Signature: Date: Signature: Date: N J D ivision of Revenue, POB ox 308, Trenton, NJ 08646 American LegalNet, Inc. www.USCourtForms.com>>>> 2Rev 7/11/05 Instructions for Form C-159A CERTIFICATE OF DISSOLUTION, BEFORE COMMENCING BUSINESS Domestic For-Profit and Non-profit Corporations (Titles 14A AND 15A) STATUTORY FEE: No Fee The MANDATORY fields are: Statutory Authority Check the appropriate statutory authority (14A:12-2 or 15A:12-2). Field # 1 -- Business Name List the name as it appears on the records of the State Treasurer. Field # 2 -- Business Entity Identification Number Provide the 10-digit identification number issued by the State of New Jersey. Field #s 3&4 -- Registered Agent And Office List the agent and office as shown on the records of the State Treasurer or list current information. Field 5 -- Names(s)/ Addresses Of Incorporators And Directors (Domestic Profit Corporations) or Trustees Constituting The First Board (Domestic Non-Profit Corporations) Provide the names and addresses as indicated. Do not list the corporate address. ATTESTATIONS Provide the following statements: 1) That the corporation has not commenced business/activity and had no shares, and has no debts or other liabilities. 2) That the corporation has received no payments or subscriptions to its shares, or if it has, returned them to those entitle thereto, less any part thereof disbursed for expenses; and 3) That the sole incorporators Director, if there is only one, or both Incorporators and Directors, if there only two, or a majority of the Incorporator or Directors/Trustees, if there are more than two, has or have elected that the corporation dissolve. Form C-159A provides these statements. ATTACHMENTS For non-profits, attach a non-profit plan of dissolution. EXECUTION (DATE/SIGNATURE) Have the incorporator(s) sign. Also, list the date of execution (signature). ********** These documents are to be filed in duplicate. Non-profits must file in triplicate. All annual report obligations should be satisfied prior to submitting the dissolution paperwork. Mail to: NJ Division of Revenue, PO Box 308, Trenton NJ 08646 American LegalNet, Inc. www.USCourtForms.com