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STATE OF SOUTH CAROLINA SECRETARY OF STATE APPLICATION FOR REINSTATEMENT OF A CORPORATION DISSOLVED BY ADMINISTRATIVE ACTION
TYPE OR PRINT CLEARLY IN BLACK INK

Pursuant to Section 33-14-220 of the 1976 South Carolina Code of Laws, as amended, the undersigned hereby applies to the Secretary of State for reinstatement of a corporation dissolved by administrative action and for that purpose, submits the following information: 1. The name of the corporation is Date of incorporation 2. Complete either "a" or "b", whichever is applicable. a. [ ] Grounds for administrative dissolution did not exist. b. [ ] The grounds for administrative dissolution, which were: Date of dissolution

have now been eliminated. 3. The corporation's name satisfies the requirements of Section 33-4-101 of the 1976 South Carolina Code of Laws, as amended.

Date
Name of Corporation

Signature

Type or Print Name and Office FILING INSTRUCTIONS 1. 2. 3. Two copies of this form, one of which can be either a duplicate original or a conformed copy must be filed. Filing fee (Payable to the Secretary of State at the time of filing this application) - $25.00 THIS APPLICATION CAN BE FILED ANYTIME AFTER THE EFFECTIVE DATE OF THE CORPORATION'S DISSOLUTION BY ADMINISTRATIVE ACTION AND MUST BE ACCOMPANIED BY A CERTIFICATE FROM THE SOUTH CAROLINA DEPARTMENT OF REVENUE RECITING THAT ALL STATE TAXES, PENALTIES AND INTEREST OWED BY THE CORPORATION HAVE BEEN PAID. Return to: Secretary of State P.O. Box 11350 Columbia, SC 29211
DOM-APP FOR REINSTATEMENT OF CORP DISSOLVED.doc

Form Revised by South Carolina Secretary of State, January 2000