Page 1 of 6Form 560Last Revised: 06/2019 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 Page 2 of 6Form 560Last Revised: 06/2019Toll 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 (Nonprofit, Domestic Corporation) Filing Fee: $50 (139-DISM (Members) & 175-DIST (Directors)) Form Must Be Typed The corporation named below has adopted a resolution of dissolution. Location of Principal Office in Ohio Names and addresses of the directors. Name of Corporation Charter Number Name Address City State Complete the following information. Address Name Address NameForm 560 Prescribed by: County For screen readers, follow instructions located at this path. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 6Form 560Last Revised: 06/2019 Names and addresses of the officers. Name and address of the Statutory Agent. Please complete this section if the corporation is appointing a new agent. ACCEPTANCE OF APPOINTMENT The Undersigned, ,named herein as the Statutory agent for, hereby acknowledges and accepts the appointment of statutory agent for said corporation. Statutory Agent Signature The date of dissolution if other than the filing date 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 1702.47(H). Address Address Address Name Name Name dissolution date (MM/DD/YYYY) Statutory Agent Name Corporation Name Individual Agent's Signature/Signature on behalf of Business Serving as Agent Name of Statutory Agent Mailing Address City State ZIP Code American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 6Form 560Last Revised: 06/2019 Check the appropriate box and provide information as required: The resolution of dissolution was adopted: The resolution of dissolution was adopted by the Members pursuant to Ohio Revised Code section 1702.47(D). The resolution of dissolution was adopted by the Directors. Pursuant to Ohio Revised Code section 1702.47(C), directors may adopt a resolution in the following cases, please check the box to state the proper statement of the basis for the adoption. 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; or When the period of existence of the corporation specified in its articles has expired. 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 Must be signed by an authorized officer, unless the officer fails to execute and file the certificate within30 days after the adoption of the resolution, or upon any date specified in the resolution as the date upon which the certificate is to be filed, or upon the expiration of any period specified in the resolution as the period within which the certificate is to be filed,whichever is latest, in which event the certificate of dissolution may be signed by any three voting members and shall set forth a statement that the persons signing the certificate are voting members 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 Page 5 of 6Form 560Last Revised: 06/2019 Name of Corporation Signature Title Name Mailing Address City State ZIP Code Notary Public Date Notified (MM/DD/YYYY) Sworn to and subscribed in my presence on this date (MM/DD/YYYY)AFFIDAVITComplete the information in this section.In lieu of dissolution releases from various governmental authorities.The undersigned, being first duly sworn, declares that on the dates indicated below, each of the named state governmental agencies was advised IN WRITING of the scheduled date of filing of the Certificate and was advised IN WRITING of the acknowledgement by the corporation of the applicability of the provisions of section 1702.55 of the ORC. AgencyOhio Department of Taxation Dissolution Section 4485 Northland Ridge Blvd. Columbus, Ohio 43229AgencyOhio Job & Family Services Status and Liability Section Data Correspondence Control Fax: 614-752-4811 Phone: 614-466-2319Note: This affidavit must be signed by one or more persons executing the certificate or by an officer of the corporation.SealOvernight Address: P.O. Box 182413 Columbus, OH 43218-2413Regular Address: P.O. Box 182413 Columbus, OH 43218-2413 Date Commission Expires (MM/DD/YYYY) Date Notified (MM/DD/YYYY) American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of 6Form 560Last Revised: 06/2019Instructions for Certificate of DissolutionThis form should be used for a nonprofit, domestic corporation to file a certificate of dissolution pursuant to Ohio Revised Code section 1702.47. Corporation Information Please provide the name of the corporation and the charter number assigned by our office. Also, please provide th