_________________________
Name of Corporation
*6.
The date dissolution of the corporation was authorized: __________________________.
*7.
If a delayed effective date of dissolution is needed to be put on record in our office, it
should be entered here: _________________.
(NOTE: By leaving this blank, the dissolution date shall be
effective upon acceptance of this document for filing by the Secretary of State.)
8.
Selection of 8a OR 8b should be made here, NOT BOTH:
*8(a)
The dissolution was approved by the incorporators or initial directors:
1.
The date of incorporation: __________________________________
(Must match date on record with Secretary of State’s Office)
2.
Check (a) OR (b), whichever is applicable:
(a) _____ No shares have been issued by the corporation;
(b) _____ The corporation has not commenced business.
3.
The corporation has no outstanding debts.
(By signing this document,
you are confirming this statement is true).
4.
After winding up, the net assets of the corporation have been distributed
to the shareholders, only if shares were issued.
(By signing this document, you
are confirming this statement is true).
5.
A majority of the incorporators or initial directors authorized the
dissolution.
(By signing this document, you are hereby confirming this statement is
true).
*8(b)
The dissolution was approved by the corporation’s shareholders as follows:
Voting Group:
________
Number of Outstanding Shares:
________
Number of Votes Entitled to be cast:
________
Number of Votes Represented at meeting:
________
Number of undisputed shares
For:____
___
A
gainst:_______