C-159C Rev. 7/92 

                                             State of New Jersey 

                                             CERTIFICATE OF DISSOLUTION 
                                             Without Assets  
                                             (Title 14A:12-4. 1) 
                                                      
1.  Name of Corporation: 
 
2.  Corporation Number: 
 
3.  Set forth the name and address of the shareholders executing the certificate OR the name, address 
 and title of the officer executing the certificate; 
 
4.  The corporation has no assets, has ceased doing business and does not intend to recommence doing 
 business, and has not made any distributions of cash or property to the shareholders within the last 
 24 months and does not intend to have any distribution following its dissolution. 
 
5.  The shareholders have authorized the dissolution by signing the Certificate of Dissolution in person or 
 by proxy, or the board and the shareholders have authorized the dissolution as provided by law, or 30 
 days prior written notice of the dissolution has been mailed to or personally served upon all known 
 directors and shareholders at their last known address and not one of them has objected to the 
 dissolution. 
 
6.  The shareholders/officers executing the certificate believe(s) that all of the statements in the certificate 
 are true under penalty of perjury. 
 
                  Signature:                                                                                                  Date: 
 
                  Signature:                                                                                                  Date: 
 
                  Signature:                                                                                                  Date: 
 
                  Signature:                                                                                                  Date: 
 
                                             NJ Division of Revenue, PO Box 308, Trenton, NJ 08646 
                                              

Rev  /7 11 5/0    
                             Instructions for Form C-159C 
                                                              
                  CERTIFICATE OF DISSOLUTION, WITHOUT ASSETS 
                              Domestic For- Profit 
                               (Title 14A) 
 
STATUTORY FEE:  No Fee 
The MANDATORY fields are:  
 
Field # 1 -- Business Name 
    List the name as it appears on the records of the State Treasurer. 
     
Field # 2 – Corporation Number 
    Provide the 10-digit business entity identification number issued by the State of 
    New Jersey. 
     
Field # 3 -- Names(s)/ Addresses Of Shareholders Executing The Certificate   or  
 Name, Title And Address Of The Officer Executing The Certificate 
    Provide the names and addresses as indicated. 
     
ATTESTATIONS 
    Provide statements that indicate:  
    1)  The corporation has no assets; has ceased doing business; does not intend to 
      recommence business; has not made any distributions of cash or property to 
      shareholders within the last 24 months; and does not intend to have any 
      distributions following its dissolution.  
    2)  The shareholders have authorized the dissolution by signing the certificate in 
      person or by proxy; or the board and shareholders have authorized the 
      dissolution as provided by law; or 30 days prior, written notice of the 
      dissolution has been mailed to or personally served upon all known directors 
      and shareholders at their last known address and not one of them objected to 
      the dissolution. 
    3)  The shareholders/officers executing the certificate believe(s) that all of the 
      statements in the certificate are true under penalty of perjury. 
     
EXECUTION (DATE/SIGNATURE) 
    Have all shareholders OR any officer sign. Also, list the date of execution 
    (signature). 
     
                                                  ********** 
     
These documents should be filed in duplicate.  
All annual report obligations should be satisfied prior to submitting the dissolution paperwork. 
 
Mail to: NJ Division of Revenue, PO Box 308,Trenton, NJ 08646