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IN THE CHANCERY COURT OF THE JUDICIAL DISTRICT OF COUNTY, MISSISSIPPI CAUSE NO. IN RE: PETITION FOR REINSTATEMENT OF DISSOLVED CORPORATION COMES NOW , hereinafter referred to as "Petitioner" and exhibits this its Petition for Reinstatement and respectfully would show unto the Court the following facts and matte rs, to-wit: 1. That, Petitioner, is a for-profit corporation organized and existing under the laws of the State of Mississippi. 2. That, Petitioner was administratively dissolved by the Secretary of State of Mississi ppi on , . A true and correct copy of the Secretary of State's Certificate of Dissolution is attached hereto as Exhibit " " and is herein incorporated by reference. 3. That, pursuant to the Mississippi Code of 1972, as amended, Section 79-5-5.04, the Office of the Secretary of State has on , served written notice upon the Petitioner concerning its denial of the Petitioner's application for reinstatement following administrative dissolution which sets forth the reason or reasons for said denial. A true and correct copy of the Secretary of State's Notice of Denial is attached hereto as Exhibit " " and is herein incorporated by reference. 4. That, pursuant to Mississippi Code of 1972, as amended, Section 79-4-23, entitled "Appeal From Denial of Reinstatement", the Petitioner files this Petition for Corporat e Reinstatement within ( ) days after service of the notice of the denial. The Petitioner can show and substantiate good cause for this Court to set aside the dissolution of the corporate status, and reinstate the Petitioner to corporate status and good standing. 5. That, Petitioner has filed all tax returns due the Mississippi State Tax Comm ission as evidenced by a copy of the Mississippi State Tax Commission certificate letter a ttached hereto as Exhibit " " and which is herein incorporated by reference. 6. That, pursuant to Section 79-4-14.23 of the Mississippi Code of 1972, as amended, this Court has the authority to order summarily the Secretary of State of Mississippi to rei nstate the Petitioner's corporate status. 7. That, pursuant to Section 79-4-14.22 of the Mississippi Code of 1972, as amended, the reinstatement shall relate back to and take effect as of the effective dat e of the administrative dissolution and Petitioner may continue and resume carrying on its business as if the administrative dissolution had never occurred. WHEREFORE, PREMISES CONSIDERED, Petitioner prays that this Petition be received and examined by the Court, and upon a hearing of this matter that the Court will enter a Decree ordering the Secretary of State of Mississippi to reinstate Petitioner's corporate status retroactive to the date of the administrative dissolution. FURTHER, if the Petitioner has prayed for wrong or improper relief, then Petitioner prays for such other relief as the Court deems to be correct and proper in the premi ses and under the terms of this petition. FURTHER, Petitioner prays for general relief. Respectfully submitted, _______________________________________ Attorney for Of counsel: Telephone: MSB # Attorney for SWORN TO AND SUBSCRIBED BEFORE ME, this the day of , 20 . ____________________________________ NOTARY PUBLIC MY COMMISSION EXPIRES: