Form Dc-7 - Statement Of Cancellation Of Acquired Shares - 2004
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FORM DC-7
WWW.
USINESS
7/2004
Nonrefundable Filing Fee: $25.00
STATE OF HAWAII
*DC7*
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
Business Registration Division
Clear Form
335 Merchant Street
Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810
STATEMENT OF CANCELLATION OF ACQUIRED SHARES
(Section 414-102, 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:
1. The name of the corporation is:
______________________________________________________________________________________________________________
2. The total number of shares the corporation is authorized to issue is:
CLASS/SERIES
NUMBER OF SHARES
3.
The number of acquired shares cancelled is:
CLASS/SERIES
NUMBER OF SHARES
4.
The total number of authorized shares remaining after the reduction of the shares is:
CLASS/SERIES
NUMBER OF SHARES
The undersigned certifies under the penalties of Section 414-20, Hawaii Revised Statutes, that the undersigned has 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 articles must be signed by at least one officer of the corporation.
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