Statement Of Cancellation Of Acquired Shares {DC-7}

WWW.BUSINESSR EGISTRATIONS.COM FORM DC-7 7/2001Nonrefundable Filing Fee: $50.00 STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS Business Registration Division $ 1010 Richards 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 theabove statements and that the same are true and correct. Signed this ____________day of ___________________________________, __________ _______________________________________________________ ________________________________________________________ ( Type/P rint Name & Title) (Signature of Officer)SEE INSTRUCTIONS ON REVERSE SIDE. The articles must be signed by at least one officer of the corporation. <<<<<<<<<********>>>>>>>>>>>>> 2 FORM DC-7 7/2001Instructions : Statement must be typewritten or printed in black ink, and must be legible . The statement must be signed byat least one officer of the corporation. All signatures must be in black ink. Submit original statement together with theappropriate fee. Statement must be filed before the filing of the corporations next annual report. Line 1. State the full name of the corporation. Line 2. State the total number of authorized shares, by class or series, prior to the cancellation. Line 3. State the number of acquired shares, by class or series, that are being cancelled. Line 4. State the total number of authorized shares, by class or series, remaining after the reduction. Filing Fees : Filing fee ($50.00) is not refundable. Make checks payable to DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS. Dishonored Check ($15 fee plus interest charge). NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE DIVISION SECRETARY, BUSINESS REGISTRATION DIVISION, DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST.