Articles Of Involuntary Dissolution - Domestic {DSCB 15-1989-5989}

PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Return document by mail to: Name Address City State Zip Code Articles of Involuntary Dissolution Domestic Corporation DSCB:15-1989/5989 (rev. 7/2015) *1989* 1989 Nonprofit Corporation (§ 5989) Return document by email to: _________________________________ Read all instructions prior to completing. Fee: None Check one: Business Corporation (§ 1989) In compliance with the requirements of the applicable provisions (relating to articles of involuntary dissolution), the undersigned officer of the office of the clerk of the court of common pleas, desiring to evidence the dissolution of a corporation, hereby certifies that: 1. The name of the corporation is: 2. The (a) address of this corporation's current registered office in this Commonwealth or (b) name of its commercial registered office provider and the county of venue is: (Complete only (a) or (b), not both) (a) Number and Street City State Zip County (b) Name of Commercial Registered Office Provider c/o: County 3. The court, term and number or other identification of the proceeding in which a decree dissolving the corporation was entered is: American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-1989/5989 ­ 2 4. Check one of the following: The costs and expenses of the foregoing proceeding and the liabilities of the corporation have been discharged and all the remaining assets of the corporation, if any, have been distributed as provided in 15 Pa.C.S. Subch. 19G or 59G (relating to involuntary liquidation and dissolution. The assets of the corporation are not sufficient to discharge such costs, expenses and liabilities, and all the assets of the corporation have been applied, as far as they will go, to the payment of such costs, expenses and liabilities. 5. A certified copy of the decree of dissolution is set forth in full in Exhibit A attached hereto and made a part hereof. IN TESTIMONY WHEREOF, the undersigned officer of the office of the clerk of the court of common pleas has executed these Involuntary Articles of Dissolution this day of , . Name of Court Signature Title American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-1989/5989­Instructions Pennsylvania Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 web site: www.dos.pa.gov/corps Instructions for Completion of Form: A. Typewritten is preferred. If handwritten, the form shall be legible and completed in black or blue-black ink in order to permit reproduction. There is no filing fee with respect to this form. Enter the name and mailing address to which any correspondence regarding this filing should be sent. This field must be completed for the Bureau to return the filing. If the filing is to be returned by email, an email address must be provided. An email will be sent to address provided, containing a link and instructions on how a copy of the filed document or correspondence may be downloaded. Any email or mailing addresses provided on this form will become part of the filed document and therefore public record. B. Under 15 Pa.C.S. § 135(c) (relating to addresses) an actual street or rural route box number must be used as an address, and the Department of State is required to refuse to receive or file any document that sets forth only a post office box address. C. The following shall accompany this form: (1) A certified copy of the order of dissolution. (2) Any necessary governmental approvals. D. No tax clearance certificates from the Department of Revenue or from the Bureau of Employment Security of the Department of Labor and Industry evidencing payment of all taxes and charges payable to the Commonwealth are required to be submitted with this form, under the presumption that they have been filed with the Court. E. This form and all accompanying documents shall be mailed to the address stated above. American LegalNet, Inc. www.FormsWorkFlow.com