Nonrefundable Filing Fee: $25.00
STATE OF HAWAII
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
Business Registration Division
335 Merchant Street
Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810
Phone No. (808) 586-2727
STATEMENT OF ISSUANCE OF SHARES OF PREFERRED OR
SPECIAL CLASSES IN SERIES
(Section 414-72, Hawaii Revised Statutes)
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK
The undersigned, duly authorized officer of the corporation submitting this Statement, certifies as follows:
The name of the corporation is:
A copy of the resolution establishing and designating the series, and fixing and determining the relative rights and
preferences of the new shares is attached.
The resolution was adopted on: _______________________________________________________________________
The resolution was adopted by the Board of Directors.
The undersigned certifies under the penalties of Section 414-20, Hawaii Revised Statutes, that the undersigned has read the
above statements, I/we are authorized to make this change, and that the statements are true and correct.
Signed this ____________day of ___________________________________, __________
(Type/Print Name & Title)
(Signature of Officer)
Instructions: Statement must be typewritten or printed in black ink, and must be legible. The statement must be signed by at
least one officer of the corporation. All signatures must be in black ink. Submit original statement together with the appropriate
Line 1. State the full name of the corporation.
Line 2. Attach a copy of the resolution. Attachment must be typewritten or printed in black ink on 8-1/2 x 11 white, bond paper
and printed only on one side.
Line 3. Give the date (month, day and year) that the Board of Directors adopted the resolution. Authority for the Board of
Directors to adopt the resolution must be stated in the corporation’s Articles of Incorporation.
Filing Fees: Filing fee ($25.00) is not refundable. Make checks payable to DEPARTMENT OF COMMERCE AND
CONSUMER AFFAIRS. Dishonored Check Fee $25.00.
For any questions call (808) 586-2727. Neighbor islands may call the following numbers followed by 6-2727 and the # sign:
Kauai 274-3141; Maui 984-2400; Hawaii 974-4000, Lanai & Molokai 1-800-468-4644 (toll free).
Fax: (808) 586-2733
NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE
DIVISION SECRETARY, BUSINESS REGISTRATION DIVISION, DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST.
ALL BUSINESS REGISTRATION FILINGS ARE OPEN TO PUBLIC INSPECTION. (SECTION 92F-11, HRS)