Form Form Dc-7 - Statement Of Cancellation Of Acquired Shares - State Of Hawaii printable pdf download

Form Form Dc-7 - Statement Of Cancellation Of Acquired Shares - State Of Hawaii

FORM DC-7

WWW.

USINESS

1/2001

Nonrefundable Filing Fee: $50.00

STATE OF HAWAII

DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS

Business Registration Division

1010 Richards Street

Clear Form

Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810

STATEMENT OF CANCELLATION OF ACQUIRED SHARES

(Section 415-6, Hawaii Revised Statutes)

PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK

The undersigned, duly authorized officers of the corporation submitting this Statement, certify as follows:

The name of the corporation is:

_______________________________________________________________________________________________________________

The total number of shares the corporation is authorized to issue is:

CLASS/SERIES

NUMBER OF SHARES

The number of acquired shares cancelled is:

CLASS/SERIES

NUMBER OF SHARES

The total number of authorized shares remaining after the cancellation is:

CLASS/SERIES

NUMBER OF SHARES

We certify under the penalties of Section 415-136, Hawaii Revised Statutes, that we have read the above statements and that

the same are true and correct.

Signed this ____________day of ___________________________________, __________

_______________________________________________________

_________________________________________________________

(Type/Print Name & Title)

_______________________________________________________

_________________________________________________________

(Signature of Officer)

SEE INSTRUCTIONS ON REVERSE SIDE. The statement must be signed by two individuals who are officers of the

corporation.

Form Form Dc-7 - Statement Of Cancellation Of Acquired Shares - State Of Hawaii