State of North Carolina Department of the Secretary of State APPLICATION FOR REINSTATEMENT FOLLOWING ADMINISTRATIVE DISSOLUTION Pursuant to 24755 - 14 - 22 of the North Carolina General Statutes, the undersigned corporation hereby submits this Application for Reinstatement Following Administrative Dissolution. 1. The name of the applicant corporation is: 2. The effective date of the administrative dissolution of the applicant corporation : 3. The ground or grounds for administrative dissolution of the applicant corporation as stated in its Certificate of Dissolution was or were: 4. Complete eit her (a) or (b) as appropriate: (a) The grounds stated above for the administrative dissolution of the applicant corporation did not exist. (Insert brief explanation.) (b) The grounds stated above for the administrative dissolution of the applicant corporation have been eliminated. (Insert brief explanation.) 5 . Enclosed is a fee of $100 as required by 24755 - 1 - 22 of the North Ca rolina General Statutes. This is the day of , 20 . ( Name of Applicant Corporation) (Signature) (Type or Print Name and Title) NOTES: 1. The filing fee for this Application is $100. 2. This application must be filed with the Secretary of State. BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626 - 0622 (Revised September 2017) (Form B - 08) American LegalNet, Inc. www.FormsWorkFlow.com