Secretary of State 
                                                                Business Programs Division 
                                                                            Business Entities 
                                                   1500 11th Street, Sacramento, CA 95814 
                                               P.O. Box 944260, Sacramento, CA 94244-2600 

                                                   Submission Cover Sheet

For faster service, file online at bizfileOnline.sos.ca.gov               . 

Instructions: 

• Complete and include this form with your paper submission. This information only will be
  used to communicate in writing about the submission, if needed. This form will be
  treated as correspondence and will not be made part of the filed document.

• Make all checks or money orders payable to the Secretary of State.

• In person submissions (excluding Statements of Information): $15 handling fee; do not include
  a $15 handling fee when submitting documents by mail.

• Standard processing time for submissions to this office is approximately 5 business days from
  receipt. All submissions are reviewed in the date order of receipt with online submissions
  given priority. For updated processing time information, visit
  www.sos.ca.gov/business/be/processing-dates.

Optional Copy and Certification Fees: 

• If applicable, include optional certification fees with your submission.

• For applicable certification fee information, refer to the instructions of the specific form you are
  submitting.

Contact Person: (Please type or print legibly) 

First Name:                                      Last Name: 

Phone (optional):  

Entity Information: (Please type or print legibly) 

Name:  

Entity Number (if applicable):  

Address: 

Comments

Submission Cover Sheet (REV 03/2022)                            Clear Form  Print Form

                Secretary of State                               ELEC STK

                Certificate of Election to Wind Up and 
                Dissolve 
                (California Stock Corporation ONLY) 

There is No Fee for filing a Certificate of Election to Wind Up and 
Dissolve - Stock 

Certification Fee (Optional) –  $5.00

                                                                                            This Space For Office Use Only 
1. Corporate Name       (Enter the exact name of the corporation as it is recorded 2. Secretary of State           Entity Number
   with the California Secretary of State.)

                     (Check the applicable statement. Only one box may be checked. If the first box is checked, enter the           number of 
3. Election          shares (do not enter the percentage of shares).  Note:  This Form ELEC STK is not required when the vote to dissolve 
                     was made by all of the shareholders and that fact is noted on the Certificate of Dissolution (Form DISS STK).) 

   The election was made by the vote of   ___________________________  shares of the corporation, and representing at 
   least 50 percent of the voting power.        
   The corporation has not issued any shares; the election was made by the board of directors of the corporation. 

4. Required Statement        (This Statement is required.  Do not alter.)

The corporation has elected to wind up and dissolve. 

5. Signatory Authority       (Check the applicable statement.  Only one box may be checked.)

The undersigned is/are the: 
   Sole director or a majority of the directors now in office of the above-named corporation. 
   Chairperson  of  the  board,  president  or  vice  president  and  the  secretary,  chief  financial  officer,  treasurer, 
   assistant secretary or assistant treasurer of the above-named corporation. 
   Shareholder(s) authorized to sign this certificate by shareholders holding shares representing at least 50 percent 
   of the voting power of the above-named corporation.               

6. Read, Verify, Date and Sign Below

I declare under penalty of perjury under the laws of the State of California that the matters set forth in this certificate 
are true and correct of my own knowledge. 

  __________________          ____________________________________________          ______________________________________________ 
   Date                      Signature                                             Type or Print Name 

  __________________          __________________________________________            ______________________________________________ 
   Date                      Signature                                             Type or Print Name 

  __________________          __________________________________________            ______________________________________________ 
   Date                      Signature                                             Type or Print Name 

ELEC STK (REV 03/2022)                        Clear Form         Print Form                                        2022 California Secretary of State 
                                                                                                                        bizfileOnline.sos.ca.gov

                   Secretary of State                               DISS STK

                   Certificate of Dissolution 
                   (California Stock Corporation ONLY) 

There is No Fee for filing a Certificate of Dissolution - Stock  

Certification Fee (Optional) - $5.00

                                                                                       This Space For Office Use Only 
1. Corporate Name       (Enter the exact name of the Corporation as it is recorded  2. Secretary of State Entity Number
   with the California Secretary of State.)

3. Election

   The dissolution was made by a vote of ALL of the shareholders of the California corporation. 
   Note:  If the above box is not checked, a Certificate of Election to Wind Up and Dissolve (Form ELEC STK) must be filed prior to 
   or together with this Certificate of Dissolution.  (California Corporations Code section 1901.) 

                               (Check the applicable statement.  Only        one box  may be checked.  If second box is checked, must
4. Debts and Liabilities       include the required information in an attachment.) 

   The known debts and liabilities have been actually paid or paid as far as its assets permitted. 
   The known debts and liabilities have been adequately provided for in full or as far as its assets permitted by their 
   assumption.  Included in the attachment to this certificate, incorporated herein by this reference, is a description 
   of the provisions made and the name and address of the person, corporation or government agency that has 
   assumed or guaranteed the payment, or the depository institution with which deposit has been made.    
   The corporation never incurred any known debts or liabilities. 

5. Required Statements (Do not alter the Required Statements –            ALL must be true to file Form DISS STK.)

a. The Corporation has been completely wound up and is dissolved.
b. All final returns required under the California Revenue and Taxation Code have been or will be filed with the
   California Franchise Tax Board.
c. The known assets have been distributed to the persons entitled thereto or the corporation acquired no known
   assets.

6. Read, Verify, Date and Sign Below

The undersigned is the sole director or a majority of the directors now in office.  I declare under penalty of perjury 
under the laws of the State of California that the matters set forth in this certificate are true and correct of my own 
knowledge.   

______________            ___________________________________________               ________________________________________________ 
   Date                 Signature                                                   Type or Print Name 

_______________           __________________________________________                ________________________________________________ 
   Date                 Signature                                                   Type or Print Name 

_______________           __________________________________________                ________________________________________________ 
   Date                 Signature                                                   Type or Print Name 

DISS STK (REV 03/2022)                                                                                 2022 California Secretary of State 
                                              Clear Form         Print Form                                       bizfileOnline.sos.ca.gov