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                         DSF STK

                  Short Form Dissolution Certificate 
                  (ONLY California Stock Corporation Registered in 
                  California in the Last 12 Months) 

 There is No Fee for filing a Short Form Dissolution Certificate - 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. 7-Digit Secretary of State Entity Number
   with the California Secretary of State.)

3. Required Statements (Do not alter the Required Statements – ALL must be true to file Form DSF STK.)
Statements 3(a) – 3(g) are true: 
   a) This Short Form Certificate of Dissolution is being filed within twelve (12) months from the date the Articles of Incorporation
      were filed with the Secretary of State;
   b) The corporation does not have any debts or other liabilities, except as provided in Item 3(c);
   c) The tax liability of the corporation will be satisfied on a taxes paid basis, or a person or corporation or other business entity
      assumes the tax liability, if any, of the dissolving corporation and is responsible for additional corporate taxes, if any, that are
      assessed and that become due after the date of the assumption of the tax liability;
   d) All  final  returns  required  under  the  California  Revenue  and  Taxation  Code  have  been  or  will  be  filed  with  the  California
      Franchise Tax Board;
   e) The corporation has not conducted any business from the time of the filing of the Articles of Incorporation with the Secretary
      of State;
   f) The corporation has not issued any shares, and if the corporation has received payments for shares from investors, those
      payments have been returned to those investors;
   g) The corporation is dissolved; and
   h) The known assets remaining after payment of, or adequately providing for, the known deb s and liabilitiesthave been
      distributed to the persons entitled thereto; or the corporation acquired no known assets.
   Note:  If the corporation cannot say    all of these items are true, the corporation cannot file this Short Form Dissolution Certificate (Form 
   DSF STK) and must follow the normal dissolution process.  See Certificate of Dissolution (Form DISS STK), and if applicable, Certificate 
   of Election to Wind Up and Dissolve (Form ELEC STK). 
4. Dissolution (Check the applicable statement.  Only one box may be checked.)

      The  undersigned  sole director or a majority of the directors now in office has  authorized the dissolution and  elected to 
      dissolve the corporation. 
      No directors were named in the  original Articles of Incorporation and  none have  been elected. The  undersigned  sole 
      incorporator or a majority of the incorporators has authorized the dissolution and elected to dissolve the corporation. 
 Note:  The second box cannot be checked if the corporation has filed a Statement of Information with the California Secretary of State. 

5. 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 

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