COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. STATE OF SOUTH CAROLINA SECRETARY OF STATE : Plaintiff(s) JUDICIAL SUBPOENA APPLICATION FOR REINSTATEMENT OF -against: A NONPROFIT CORPORATION DISSOLVED BY ADMINISTRATIVE ACTION : : TYPE OR PRINT CLEARLY IN BLACK INK Defendant(s) : . .Pursuant .to .Section. 33-31-1422.of.the. 1976 .South .Carolina. Code of Laws, as amended, the undersigned ....... . ..... ......... . .. .... .... ...... .... hereby applies to the Secretary of State for reinstatement of a nonprofit corporation dissolved by administrative action and for that purpose, submits the following information: 1. The OF THE STATE OF NEW YORK THE PEOPLEname of the corporation at the time of dissolution was TO 2. And the effective date of the administrative dissolution was ____________________. Complete either “a” or “b”, whichever is applicable a. [ ] Grounds for administrative dissolution did not exist. GREETINGS: b. [ ] The grounds for administrative dissolution, which were WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the , 20 , at o'clock in the noon, and at any recessed have now been day of eliminated. or adjourned date, to testify and give evidence as a witness in this action on the part of the 3. The corporation's name satisfies the requirements of Section 33-31-401 of the 1976 South Carolina Code of Laws, as amended. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Date the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Name of Corporation result of your failure to comply. Witness, Honorable Court in County, Signature day of , one of the Justices of the , 20 Type or Print Name and Office (Attorney must sign above and type name below) FILING INSTRUCTIONS 1. Two copies of this form, one of which can be either a duplicate original or a conformed copy, must be filed. 2. Filing fee (Payable to the Secretary of State at the time of filing this application) - $25.00 3. THIS APPLICATION MUST BE FILED WITHIN TWO YEARS AFTER THE EFFECTIVE DATE OF THE CORPORATION'S DISSOLUTION BY ADMINISTRATIVE ACTION AND MUST BE ACCOMPANIED BY A CERTIFICATE FROM THE SOUTH CAROLINA DEPARTMENT OF REVENUE RECITING THAT ALL STATE TAXES OWED BY THE CORPORATION HAVE BEEN PAID. Attorney(s) for Office and P.O. Address Return to: Secretary of State P.O. Box 11350 Columbia, SC 29211 NP-APP FOR REINSTATEMENT OF A NP DISSOLVED.doc Telephone No.: Facsimile No.: Form Approved by South Carolina E-Mail Address: Secretary of State, January 2000 Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com