Free $10.00 - Alaska

State of Alaska Department of Community and Economic Development Division of Banking, Securities, and Corporations CORPORATION SECTION PO Box 110808 Juneau AK 99811-0808

CERTIFICATE OF ELECTION
Religious Corporation
1. Name of the corporation: Alaska Entity #:

2. The name, title and address of the incorporator or successor:

Printed Name Mailing Address: City: 3. The corporation has elected to wind up and dissolve.

Title:

State:

ZIP Code:

Signed this Signature Printed Name Mailing Address:

day of

, 20

.

Title:

City:

State:

ZIP Code:

If you have specific legal questions or concerns about this filing, you are strongly advised to consult an attorney or other professional to assist you. Mail the completed filing and the $10.00 filing fee (in U.S. dollars) to: State of Alaska Corporations Section PO Box 110808 Juneau, AK 99811 For additional information or forms please visit our web site at: www.corporations.alaska.gov

08-413 (Rev. 08/04) alh

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