PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Domestic Limited Liability Company (15 Pa.C.S.) Certificate of Dissolution (§ 8975) Certificate of Dissolution by Domestication (§ 8978) Document will be returned to the name and address you enter to the left. Name Address City State Zip Code Fee: $70 In compliance with the requirements of the applicable provisions (relating to certificate of dissolution/dissolution by domestication), the undersigned limited liability company, desiring to dissolve, hereby states that: 1. The name of the limited liability company is: Certificate of Dissolution - complete paragraphs 2, 3, and 4 2. Check one of the following: All debts, obligations and liabilities of the limited liability company have been paid or discharged. Adequate provision has been made for the payment and discharge of the debts, obligations and liabilities of the limited liability company. Assets of the limited liability company are not sufficient to discharge its liabilities, and all the assets of the limited liability company have been fairly and equitably applied, as far as they will go, to the payment of such liabilities. 3. All remaining property and assets of the limited liability company, if any, have been distributed among its members in accordance with their respective rights and interests. 4. Check one of the following: There are no actions or proceedings pending against the limited liability company in any court. Adequate provision has been made for the satisfaction of any judgment or decree that may be obtained against the limited liability company in each action or proceeding pending against the limited liability company. American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-8975/8978–2 Certificate of Dissolution by Domestication - complete paragraph 5 5. The limited liability company has domesticated itself under the laws of . Name of Jurisdiction IN TESTIMONY WHEREOF, the undersigned limited liability company has caused this Certificate to be signed by a duly authorized member or manager thereof this day of , . Name of Limited Liability Company Signature Title American LegalNet, Inc. www.FormsWorkFlow.com Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 web site: www.dos.state.pa.us/corps Instructions for Completion of Form: A. Typewritten is preferred. If not, the form shall be completed in black or blue-black ink in order to permit reproduction. The filing fee for this form is $70 made payable to the Department of State. B. The following, in addition to the filing fee, shall accompany this form: (1) Tax clearance certificates from the Department of Revenue and from the Bureau of Employment Security of the Department of Labor and Industry evidencing payment of all taxes and charges payable to the Commonwealth (2) Any necessary governmental approvals. C. This form and all accompanying documents shall be mailed to the address stated above. American LegalNet, Inc. www.FormsWorkFlow.com