C-159C Rev. 7/92 State of New Jersey CERTIFICATE OF DISSOLUTION Without Assets (Title 14A:12-4. 1) 1. Name of Corporation: 2. Corporation Number: 3. Set forth the name and address of the shareholders executing the certificate OR the name, address and title of the officer executing the certificate; 4. The corporation has no assets, has ceased doing business and does not intend to recommence doing business, and has not made any distributions of cash or property to the shareholders within the last 24 months and does not intend to have any distribution following its dissolution. 5. The shareholders have authorized the dissolution by signing the Certificate of Dissolution in person or by proxy, or the board and the shareholders have authorized the dissolution as provided by law, or 30 days prior written notice of the dissolution has been mailed to or personally served upon all known directors and shareholders at their last known address and not one of them has objected to the dissolution. 6. The shareholders/officers executing the certificate believe(s) that all of the statements in the certificate are true under penalty of perjury. Signature: Signature: Signature: Signature: Date: Date: Date: Date: NJ Division of Revenue, PO Box 308, Trenton, NJ 08646 American LegalNet, Inc. www.USCourtForms.com Rev 7/11/05 Instructions for Form C-159C CERTIFICATE OF DISSOLUTION, WITHOUT ASSETS Domestic For- Profit (Title 14A) STATUTORY FEE: No Fee The MANDATORY fields are: Field # 1 -- Business Name List the name as it appears on the records of the State Treasurer. Field # 2 ­ Corporation Number Provide the 10-digit business entity identification number issued by the State of New Jersey. Field # 3 -- Names(s)/ Addresses Of Shareholders Executing The Certificate or Name, Title And Address Of The Officer Executing The Certificate Provide the names and addresses as indicated. ATTESTATIONS Provide statements that indicate: 1) The corporation has no assets; has ceased doing business; does not intend to recommence business; has not made any distributions of cash or property to shareholders within the last 24 months; and does not intend to have any distributions following its dissolution. 2) The shareholders have authorized the dissolution by signing the certificate in person or by proxy; or the board and shareholders have authorized the dissolution as provided by law; or 30 days prior, written notice of the dissolution has been mailed to or personally served upon all known directors and shareholders at their last known address and not one of them objected to the dissolution. 3) The shareholders/officers executing the certificate believe(s) that all of the statements in the certificate are true under penalty of perjury. EXECUTION (DATE/SIGNATURE) Have all shareholders OR any officer sign. Also, list the date of execution (signature). ********** These documents should be filed in duplicate. 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