Free Application for Reinstatement Following Administrative Dissolution/Revocation - Tennessee

For Office Use Only

Corporate Filings 312 Eighth Avenue North 6th Floor, William R. Snodgrass Tower Nashville, TN 37243

APPLICATION FOR REINSTATEMENT FOLLOWING ADMINISTRATIVE DISSOLUTION/REVOCATION

Pursuant to the provisions of Section 48-24-203 or Section 48-25-303 of the Tennessee Business Corporation Act or Section 48-64-203 or Section 48-65-303 of the Tennessee Nonprofit Corporation Act, this application is submitted to the Office of the Secretary of State, State of Tennessee, for reinstatement. 1. The name of the corporation is (Name change if applicable) 2. The effective date of its administrative dissolution/revocation is day, and year). 3. The ground(s) for the administrative dissolution/revocation did not exist. has/have been eliminated. [NOTE: Please mark the applicable box.] (must be month,

4. The corporate name as listed in number one (1) satisfies the requirements of Tennessee Code Annotated Section 48-14-101 or 48-54-101, as appropriate. 5. The corporation control number as assigned by the Secretary of State, if known is [NOTE (APPLIES TO FOR-PROFIT CORPORATIONS ONLY): 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-4439 (Rev. 7/01)

Filing Fee: $70.00

RDA 1678