Form A-5088-Tc - Application For Tax Clearance Certificate Page 2

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NOTES

A. If all state taxes, fees, penalties and interest have been paid or secured, a Certificate of the Director evidencing such payment will be forwarded to

the Division of Revenue or the party designated on the front of the application.

B. If all such state taxes, fees, penalties and interest have not been paid, advice thereof will be given to the applicant.

C. The Tax Clearance Certificate shall be void 45 days after date of issuance, except that where a certificate is issued during the last month of taxpayer’s

accounting period, such certificate shall be void after the last day of such accounting period. If said certificate is not filed with the Division of Revenue

within the period specified therein, applicant must reapply and submit a new application and $25.00 fee in order to accomplish the purpose for which

the original application was filed.

D. Instructions for filing tax returns can be found on the form “Procedure for Dissolution, Withdrawal or Surrender”. (A-5033-TC).

INSTRUCTIONS

1. Application for Tax Clearance Certificate must be typewritten or printed.

2. Great care should be taken to have the corporate name spelled correctly, as even a slight misspelling will generally make it difficult to identify the

corporation for which the application is made. Be sure to include the State and date of incorporation, or date of authorization.

3. Complete answers to all questions applicable to the corporation must be given. Attach rider where necessary.

SPECIAL INSTRUCTIONS

WHERE TAXPAYER DESIRES TO COMPLETE ITS PROCEEDINGS FOR DISSOLUTION, MERGER, ETC. NO LATER THAN THE END OF A

FISCAL YEAR IN PROGRESS, APPLICATION SHOULD BE SUBMITTED AT LEAST NINETY (90) DAYS PRIOR TO THE CLOSE OF SUCH FISCAL YEAR

TO ALLOW SUFFICIENT TIME FOR PROCESSING AND FOR THE SUBMISSION OF ANY REQUIRED ADDITIONAL DATA OR PAYMENTS.

FOR DIVISION USE ONLY

Estimated Summary

Check $___________________________

________ Return

Check $___________________________

Affidavit Per Instruction 3 of