S                                                                  (225) 925-4704  
                                         TATE OF LOUISIANA                                                 Commercial Division    
                                        SECRETARY OF STATE                                                   
    R. Kyle Ardoin                                                                                         Fax Numbers 
SECRETARY OF STATE                                                                                         (225) 932-5314 Corporations 
                                                                                                           (225) 932-5317 Legal Services 
                                                                                                           (225) 932-5318 UCC 
                                                                                                                                               
                            TRANSMITTAL INFORMATION 
                                  For All Business Filings

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     Routine         Expedite $30                         Priority Expedite $50
                     24 hour processing                  2-4 hour processing

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Business Name (List  exactly  as it appears in documents)

Name of person filing document (evidence of filing will be mailed to this person, at address below)

Address

City                                     State                                                     Zip Code

Daytime phone number                    Fax number                                                 Email address

NOTE:  Louisiana Law requires all Louisiana notaries to print or type their name and notary or 
       bar roll number on the document.

                     Mailing Address:  P. O. Box 94125, Baton Rouge, LA * 70804-9125      
                     Office Location: 8585 Archives Ave.,  Baton Rouge, LA * 70809          
                                  Web Site Address:   www.sos.la.gov

 SS984  Rev. 06/18

            R. Kyle Ardoin
Secretary of State        AFFIDAVIT TO DISSOLVE CORPORATION
                             (R.S. 12:250.1)

                          Domestic Non Profit Corporation  Return to:  Commercial Division
                          Enclose $75 filing fee                          P.O. Box 94125
                                                                          Baton Rouge, LA 70804-9125     
                          Make remittance payable to                      (225) 925-4704
                          Secretary of State                              www.sos.la.gov
                          Do Not Send Cash

STATE OF

PARISH/COUNTY OF

BEFORE ME, the undersigned Notary Public in and for the parish/county herein above shown, personally came
and appeared the undersigned who, after being duly sworn, did depose and say that:

                          Corporation Name

is no longer doing business and owes no debts is dissolved by filing this affidavit with the Secretary of State, 
executed by the shareholder(s), or incorporator(s) attesting to such facts. such facts.

The undersigned further declared that they are: (check one)

                 (  )     The shareholders of the above named corporation.

                 (  )     The incorporators of the above named corporation and no shares have been issued.

                                                 Incorporator(s) or Shareholder(s) Signature(s)

Sworn to and subscribed before me, the undersigned Notary Public, on this date:

                          Notary Signature, Printed name and Notary/Bar Roll #

SS339 Rev. 05/18                                                                       (See instructions on back)

                                     INSTRUCTIONS

1. File this form, along with the appropriate filing fee with the Secretary of State’s office.

2. You will receive a Certificate of Dissolution, a copy of which should be filed
   with the clerk of court where the corporation maintains its registered office. If the 
   corporation’s registered office is located in Orleans Parish, a Certificate of Dissolution 
   must be filed with the recorder of mortgages.