FLORIDA DEPARTMENT OF STATE  
                                        DIVISION OF CORPORATIONS 
 
Section 617.1403, Florida Statutes, provides for the dissolution of a corporation that has commenced to 
conduct its affairs. 
 
The document must be typed or printed and must be legible. 
 
Pursuant to section 617.0123, Florida Statutes, a delayed effective date may be specified but may not be later than 
  th
the 90  day after the date on which the document is filed. 
 
NOTE: A Notice of Corporate Dissolution form is attached. This notice pursuant to section 617.1407, Florida 
Statutes is optional and is not required when filing a dissolution. No additional fee is required if it is included.  
 
               FEES: 
               Articles of Dissolution           $  35.00 (Includes a letter of acknowledgment) 
               Certified Copy (optional)         $    8.75 
               Certificate of Status (optional)  $    8.75 
 
Send one check in the total amount made payable to the Florida Department of State. 
 
Please include a  letter containing  your telephone number, return address  and  certification requirements, or 
complete the attached cover letter. 
 
    Mailing Address:                                       Street Address: 
    Amendment Section                                      Amendment Section 
    Division of Corporations                               Division of Corporations 
    P.O. Box 6327                                          The Centre of Tallahassee 
    Tallahassee, FL 32314                                  2415 N. Monroe Street, Suite 810 
                                                           Tallahassee, FL 32303 
 
For further information, you may contact the Amendment Section at (850) 245-6050. 
 
CR2E059 (4/15) 
 

                                                                          COVER LETTER 
     
    TO:   Amendment Section 
            Division of Corporations 
     
    SUBJECT:                                                                                                      
     
    DOCUMENT NUMBER:                                                                                              
     
    The enclosed Articles of Dissolution and fee are submitted for filing. 
     
    Please return all correspondence concerning this matter to the following: 
     
                                             (Name of Contact Person) 
     
                                                            (Firm/Company) 
     
                                                                               (Address) 
     
                                                                        (City/State and Zip Code) 
     
    For further information concerning this matter, please call: 
     
                                                                              at (                      )                                        
                 (Name of Contact Person)                                           (Area Code)            (Daytime Telephone Number)   
     
        Enclosed is a check for the following amount:  
  
      ☐$35 Filing Fee ☐ $43.75 Filing Fee &   ☐$43.75 Filing Fee &   ☐$52.50 Filing Fee, Certificate of 
                          Certificate of Status        Certified Copy               Status & Certified Copy                                                                                      
                                                                           (Additional copy is enclosed)        (Additional copy is enclosed) 
                                                                             
     Mailing Address:                                                                    Street Address: 
     Amendment Section                                                                   Amendment Section 
     Division of Corporations                                                            Division of Corporations 
     P.O. Box 6327                                                                       The Centre of Tallahassee 
     Tallahassee, FL 32314                                                               2415 N. Monroe Street, Suite 810 
                                                                                         Tallahassee, FL 32303 
                                                                            

                                ARTICLES OF DISSOLUTION 
 
Pursuant to section 617.1403, Florida Statutes, this Florida not for profit corporation submits the following 
Articles of Dissolution: 
 
FIRST: The name of the corporation as currently filed with the Florida Department of State: 
 
SECOND:   The document number of the corporation (if known):                                                            
 
THIRD: Adoption of Dissolution  
       (COMPLETE SECTION I OR II) 
 
       SECTION I 
       If the corporation has members entitled to vote: 
 
       (CHECK/COMPLETE ONE) 
       ☐ The date of meeting of members at which the resolution to dissolve was adopted 
 
                                  . The number of votes cast by the members was sufficient for  
       approval.  
        
       ☐ The resolution was adopted by written consent of the members and executed in accordance 
with  
       section 617.0701, Florida Statutes.  
 
       SECTION II 
       If the corporation has no members or members entitled to vote on the dissolution: 
 
       The corporation has no members or members entitled to vote on the dissolution.  
 
       The date of adoption of the resolution by the board of directors was                                                                                   . 
 
       The number of directors in office was            and the vote for resolution was                                                                        for  
       and                  against. (Must be a majority vote) 
        
FOURTH Effective date of dissolution, if applicable:                                                                                                           
                                                         (no more than 90 days after dissolution file date) 
                Note:  If the date inserted in this block does not meet the applicable statutory filing requirements, this date will not             
                be listed as the document’s effective date on the Department of State’s records. 
 
              Signature:                                                                                                                                                                                        
                      (By the chairman or vice chairman of the board, president or other officer- if directors have not been selected, by an   
                                                 incorporator- if in the hands of a receiver, trustee, or other court appointed fiduciary, by that fiduciary) 
                                                 
                                (Typed or printed name of person signing) 
                                                 
                                  (Title of person signing)                                                           
                                                 
                                   Filing Fee: $35 
                                                 

                        Notice of Corporate Dissolution 
                                                                 
This notice is submitted by the dissolved corporation named below for resolution of payment of unknown claims 
against this corporation as provided in s. 617.1407, F.S.  
 
This "Notice of Corporate Dissolution" is optional and is not required when filing a voluntary dissolution. 
 
Name of Corporation:                                                                                                
 
Date of dissolution will be the date the dissolution is filed with the Department of State or as specified in the Articles 
of Dissolution. 
 
Description of information that must be included in a claim:  
 
Mailing address where claims can be sent: (Claims cannot be sent to the Division of Corporations) 
 
A claim against the above named corporation will be barred unless a proceeding to enforce the claim is commenced 
within 4 years after the filing of this notice. 
 
                          Printed Name of the Person Filing                    Signature of the Person Filing  
                                      
                 Fee:  No charge if included with Articles of Dissolution.  If filed separately $35.00