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Notice Of Dissent Of Shareholder

To the sale of all assets of corporation

The undersigned, a shareholder of [Corpoartion], herewith dissents and disapproves of the disposition of assets of the corporation of all of the corporate assets, which constitute [--%] percent of the assets of the corporation, to [Name], on the following terms:

Number of shares:

Class of shares: Common

The undersigned further demands their rights under the corporation law of [State].

Dated:

________________________