Form For A Certificate Of Dissolution Page 2
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1
2This document must be signed by an officer, director, attorney-in-fact or duly authorized person.
X
(Signature)
(Type or print name)
(Title or capacity of signer)
Filed by
:
(Name)
(Mailing address)
(City, State and Zip code)
CERTIFICATE OF DISSOLUTION
OF
Under Section 1003 of the Business Corporation Law
(For office use only.)
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