Last Revised: 06/2019Page 1 of 9Form 561 Toll Free: 877.767.3453 | Central Ohio: 614.466.3910 OhioSoS.gov | business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Filing Form Cover LetterPlease return the approval certificate to: Address: City: ZIP Code: Phone Number: E-mail Address: Check here if you would like to receive important notices via e-mail from the Ohio Secretary of State's office regarding Business Services. Check here if you would like to be signed up for our Filing Notification System for the business entity being created or updated by filing this form. This is a free service provided to notify you via e-mail when any document is filed on your business record. Please make checks or money orders payable to: "Ohio Secretary of State" Type of Service Being Requested: (PLEASE CHECK ONE BOX BELOW) Regular Service: Only the filing fee listed on page one of the form is required and the filing will be processed in approximately 3-7 business days. The processing time may vary based on the volume of filings received by our office. Expedite Service 1: By including an Expedite fee of $100.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 2 business days after it is received by our office. Expedite Service 2: By including an Expedite fee of $200.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 1 business day after it is received by our office. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Expedite Service 3: By including an Expedite fee of $300.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00 p.m. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Preclearance Filing: A filing form, to be submitted at a later date for processing, may be submitted to be examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The Preclearance will be complete within 1-2 business days. Name (Individual or Business Name): To the Attention of (if necessary): State American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 2 of 9Form 561Toll Free: 877.767.3453 Central Ohio: 614.466.3910 OhioSoS.gov business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Mail this form to one of the following: Regular Filing (non expedite) P.O. Box 1329 Columbus, OH 43216 Expedite Filing (Two business day processing time. Requires an additional $100.00) P.O. Box 1390 Columbus, OH 43216 Certificate of Dissolution (For-Profit, Domestic Corporation) Filing Fee: $50 Form Must Be Typed The corporation named below has adopted a resolution of dissolution. Location of Principal Office in Ohio The internet address of each domain name held or maintained by or on behalf of the corporation: Name of Corporation Charter Number City County State Complete the following information. The corporation did not hold or maintain any domain names.Form 561 Prescribed by: For screen readers, follow instructions located at this path. American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 3 of 9Form 561 Note: The date of dissolution must be on the date of filing, or a later date that is not more than 90 days after the date of filing, pursuant to Ohio Revised Code section 1701.86(F)(7). Name and address of the Statutory Agent. Please complete this section if the corporation is appointing a new agent. The date of dissolution if other than the filing date (MM/DD/YYYY) Pursuant to Ohio Revised Code section 1701.87(E), a copy of the notice required by Ohio Revised Code section 1701.87(B) must be attached to this filing. (Please attach the notice or complete page 5 of this form.) Name of Statutory Agent Mailing Address City State ZIP Code (Individual Agent's Signature / Signature on Behalf of Business Serving as Agent)Statutory Agent Signaturehereby acknowledges and accepts the appointment of statutory agent for said corporation. (Name of Corporation)Statutory agent for, named herein as theThe Undersigned, (Name of Statutory Agent)Acceptance of Appointment American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 4 of 9Form 561 Check only one box below and provide information as required: The names and addresses of all the incorporators must be set forth below: (150-DISS) (1.) The resolution of dissolution was adopted by the Incorporators. Pursuant to Ohio Revised Code section 1701.86(C), if an initial stated capital was not set forth in the articles then before the corporation begins business, or if an initial stated capital is set forth in the articles then before subscriptions to shares shall have been received in the amount of that initial stated capital, the incorporators or a majority of them may adopt, by a writing signed by them, a resolution of dissolution. (138-DISI) (2.) The resolution of dissolution was adopted by the Directors. Pursuant to Ohio Revised Code section 1701.86(D), directors may adopt a resolution of dissolution in the following cases, please check the box to state the proper statement of the basis for the adoption. (137-DISD) (3.) The articles are hereby dissolved by the Shareholders pursuant to Ohio Revised Code section 1701.86(E). Name Address Name Address Name Address When the corporation has been adjudged bankrupt or has made a general assignment for the benefit of the creditors; By leave of the court, when a receiver has been appointed in a general creditor's suit or in any suit in which the affairs of the corporation are to be wound up; When substantially all of the assets have been sold at judicial sale or otherwise; When the articles have been canceled for failure to file annual franchise or excise tax returns or for failure to pay franchise or excise taxes and the corporation has not been reinstated or does not desire to be reinstated; or When the period of existence of the corporation specified in its articles has expired.Note: Pursuant to Ohio Revised Code section 1701.86(H)(2), all domestic for-profit corporations must attach to this filing a Certificate of Tax Clearance issued by the Ohio Department of Taxation. The resolution of dissolution was adopted: American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 5 of 9Form 561 Print Name By (if applicable) Signature Print Name By (if applicable) Signature Print Name By (if applicable) SignatureBy signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she has the requisite authority to execute this document.Required When the resolution is adopted by the incorporators, the certificate shall be signed by not less than a majority of the incorporators. In all other cases, the certificate shall be signed by any authorized officer, unless the officer fails to execute and file such a certificate within 30 days after the date upon which such certificate is to be filed. In the latter event, the certificate may be signed by any three (3) shareholders or, if there are less than three (3) shareholders, all of the shareholders, form a statement that the persons signing the certificate are shareholders and are filing the certificate because of the failure of the officers to do so. If authorized representative is an individual, then they must sign in the "signature" box and print their name in the "Print Name" box. If authorized representative is a business entity, not an individual, then please print the business name in the "signature" box, an authorized representative of the business entity must sign in the "By" box and print their name in the "Print Name" box. American LegalNet, Inc. www.FormsWorkFlow.com Last Revised: 06/2019Page 6 of 9Form 561 Name of Corporation Name of Corporation Address City State Zip CodeNotice of Dissolution to Creditors and Claimants against Corporation (pursuant to ORC 1701.87)Notice of Dissolution ofan Ohio corporation (the 223corporation224) has dis