Articles Of Charter Surrender {SS-4613}

SS-4613 (01/13) Business Services Division Tre Hargett, Secretary of State State of Tennessee INSTRUCTIONS $20.00 Filing Fee ARTICLES OF CHARTER SURRENDER Articles of charter surrender may be filed using one of the following methods: · Paper submission: A blank application may be obtained by going to http://www.tn.gov/sos/forms/ss-4613.pdf, by emailing the Secretary of State at Business.Services@tn.gov, or by calling (615) 741-2286. Articles must be hand printed in ink or computer generated and mailed along with the required filing fee to the Secretary of State's office at 6th FL ­ Snodgrass Tower ATTN: Corporate Filing, 312 Rosa L. Parks AVE, Nashville, TN 37243. Walk-in: A blank articles of charter surrender form may be obtained in person at the Secretary of State Business Services Division located at 6th FL ­ Snodgrass Tower, 312 Rosa L. Parks AVE, Nashville, TN 37243. · Articles of charter surrender must be accurately completed in their entirety. Forms that are inaccurate, incomplete or illegible will be rejected. Please note that corporation surrendering its charter must have a status of "active" in order to file articles of charter surrender. Furthermore, if the corporation surrendering its charter is currently due to file an annual report with the Secretary of State at the time of filing, it must file the annual report before the Division of Business Services can file the articles of charter surrender. If the corporation does not have a status of "active" and/or owes an annual report and submits articles of charter surrender without submitting the annual report, the articles of charter surrender will be rejected. Articles of charter surrender set forth the items required under T.C.A. §48-21-113. ARTICLES OF CHARTER SURRENDER 1. Name of the corporation is ­ Enter the name of the corporation that is surrendering its charter. Secretary of State Control Number ­ Enter the Secretary of State control number of the for-profit corporation. To determine the corporation's control number, search for the corporation's details online using the Division of Business Services Business Information Search function (http://tnbear.tn.gov/Ecommerce/FilingSearch.aspx). 2. The articles of charter surrender are being filed in connection with the conversion of the corporation to a foreign unincorporated entity ­ By signing the articles of charter surrender, the signer acknowledges the statement to be true. 3. The conversion was duly approved by the shareholders in the manner required by this chapter and the charter - By signing the articles of charter surrender, the signer acknowledges the statement to be true. 4. The jurisdiction under the law of which the survivor will be organized is ­ Enter the name of the state or country under whose laws the surviving entity will be organized. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 5. If the survivor is a nonfiling entity, the address of its executive office immediately after the conversion is ­ Enter the address of the executive office of the surviving entity if the entity will not file a formation document upon formation. 6. If the document is not to be effective upon filing by the Secretary of State, the delayed effective date and time is ­ If the conversion is to take place upon a future date, enter the future date. In no event can the future date be more than ninety calendar days from the filing of the articles of entity conversion. SIGNATURE · The person executing the document must sign it and indicate the date of signature in the appropriate spaces. Failure to sign and date the document will result in the document being rejected. Type or Print Name. Failure to type or print the signature name will result in the document being rejected. Type or Print Signer's Capacity. The signer must indicate the capacity in which such person signs. Failure to indicate the signer's capacity will result in the document being rejected. FILING FEE · · The filing fee for articles of charter surrender is $20. Make check, cashier's check or money order payable to the Tennessee Secretary of State. Cash is only accepted for walk-in filings. Applications submitted without the proper filing fee will be rejected. Checks, cashier's checks or money orders made out to any payee other than the Tennessee Secretary of State will not be accepted and will result in the rejection of the document. · · Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com ARTICLES OF CHARTER SURRENDER Tre Hargett, Secretary of State State of Tennessee 312 Rosa L. Parks Ave., 6th Fl. Nashville, TN 37243 (615) 741-2286 (ss-4613) For Office Use Only Business Services Division Filing Fee: $20.00 Pursuant to the provisions of T.C.A. §48-21-113 of the Tennessee Business Corporation Act, the undersigned hereby submits these articles of charter surrender: 1. Name of the corporation is: Secretary of State Control Number: 2. The articles of charter surrender are being filed in connection with the conversion of the corporation to a foreign unincorporated entity. 3. The conversion was duly approved by the shareholders in the manner required by this chapter and the charter. 4. The jurisdiction under the law of which the survivor will be organized is: 5. If the survivor is a nonfiling entity, the address of its executive office immediately after the conversion is: 6. If the document is not to be effective upon filing by the Secretary of State, the delayed effective date and time is: (Not to exceed 90 days) Effective Date: Month / Day / Year Time: Signature Date Signature Signer's Capacity Name (printed or typed) *Note: Pursuant to T.C.A. §10-7-503 all information on this form is public record. Submitter Information: Name: SS-4613 (01/13) Phone #: ( ) RDA 1678 American LegalNet, Inc. www.FormsWorkFlow.com