Final Franchise Tax Report

M E M O R A N D U M ** 001027021n024030n030007r013027r031n027035025016007031n031r$'#$t 003n026020031025022037 004020031031022r006025013021 American LegalNet, Inc. www.FormsWorkFlow.com FOR OFFICE USE ONLY File # CORPORATION AND LIMITED LIABILITYCOMPANYFINALFRANCHISE TAX REPORTTo be submitted prior to Dissolution or Withdrawal Secretary of StateBusiness and Commercial Services DivisionLittle Rock, Arkansas 72201(501)682-3409 or (888) 233-0325www.sos.arkansas.gov 1.(Exact Corporate or Limited Liability Company Name as Registered in Arkansas)(Street and Number) 1a.(Name)(Street and Number) (City State and ZIPCode)1b. Person you wish to have contacted regarding this tax: NameAddress: (City State and ZIPCode)Phone # 2. Required Information:Please complete with current namesPresident Vice-PresidentSecretaryTreasurerControllerChairman of the Board (Check One) ForeignDomestic3. State of Incorporation/Organization4. Date of Incorporation/Organization5. Date of Organization in Arkansasa. Arkansas Registered Agentb. Nature of Business6. Federal ID Number Minimum Tax Due 1.Corporation with Authorized Stock$150.002.Corporation without Authorized Stock$300.003.Limited Liability Company$150.00County ofday of,. This form must be signed by: Pres., Vice-Pres., Sec., Treasurer, Controller or Tax Preparer E-mail Address: State ofFILED this American LegalNet, Inc. www.FormsWorkFlow.com