Articles Of Termination Following Administrative Dissolution Or Revocation (Nonprofit) {SS-4415}

Print Form For Office Use Only Corporate Filings 312 Rosa L. Parks Avenue 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 ARTICLES OF TERMINATION FOLLOWING ADMINISTRATIVE DISSOLUTION OR REVOCATION (NONPROFIT) Pursuant to the provisions of Section 48-64-205 of the Tennessee Nonprofit Corporation Act, the undersigned corporation submits the following articles of termination following administrative dissolution or revocation: 1. The name of the corporation is: 2. The termination was authorized on (month/day/year) 3. Indicate which of the following statements apply by checking the appropriate box: The resolution authorizing the termination was duly adopted by the members. The resolution authorizing the termination was duly adopted by a majority of the board of directors, as approval by the members was not required. 4. If approval by third person(s) other than the members, directors, or incorporators was required, such approval was obtained. 5. If a public benefit corporation, notice to the Attorney General, required by Section 48-64-103(a) of the Tennessee Nonprofit Corporation Act, has been given. 6. A copy of the resolution or the written consent authorizing the termination is attached. 7. All assets of the corporation have been distributed to its creditors and other parties authorized by the Tennessee Nonprofit Corporation Act. [NOTE: Prior to this document being accepted for filing, the Division of Business Services will request tax clearance verification from the Tennessee Department of Revenue that the business has properly filed all reports and paid all required taxes and penalties. If we cannot obtain such tax clearance verification from the Department of Revenue, this document will be rejected and returned to the applicant.] Signature Date Name of Corporation Signer's Capacity Signature Name (typed or printed) ss-4415 Filing Fee: $100 RDA 1678 American LegalNet, Inc. www.FormsWorkFlow.com