How to complete the form:1. List the entity222s ID number. The ID number can be found by looking up your entity in the Corporate Database.2. � List the name of the corporation. The entity name can be Corporate Database. 3. � State the number of reacquired shares of the entity cancelled by resolution adopted by the board of directors. Itemize the shares.4. � State the aggregate number of issued shares of the shares. � stated capital of the entity shall be deemed to be reduced � The entity has paid all fees and taxes. 7. � List the date the Statement of Cancellation of Reacquired Shares was duly adopted by the Board of Directors of the corporation.8. � Check 223Date received224 unless you prefer that the � MUST sign and date the form. � Entity records are retrievable and viewable through our NOT result in a mailed � Go to our Corporate Database225 � Enter the name or ID number of your entity and click 223Search224 � � � � or by mail to the Business Services Division via check made payable to the RI Department of State. Section 7-1.2-601(e) the information provided are not substitutes for the advice and services of an attorney and/or tax specialist. � � � Every entity registered with the Rhode Island Department requirements with the Rhode Island Division of Taxationeven if no business is conducted within Rhode Island for a particular year. Your business may require additional website for further information. 38-2-1 American LegalNet, Inc. www.FormsWorkFlow.com RIGL 7-1.2-601(e)other than redeemable shares redeemed or purchased. 3. The number of reacquired shares of the corporation Class Series Number of Shares 4. The aggregate number of issued shares of the corporation Class Series Number of Shares shares so cancelled shall be restored to the status of authorized but unissued shares. 7-1.2-105 (401) 222-3040 www.sos.ri.gov American LegalNet, Inc. www.FormsWorkFlow.com 7.This Statement of Cancellation of Reacquired Shares was Date American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com