Free 39080.PDF - Indiana

ARTICLES OF DISSOLUTION OF A DOMESTIC NONPROFIT CORPORATION
State Form 39080 (R6 / 12-02) Corporate Form No. 364-5 (1-88) Approved by State Board of Accounts 1995

INSTRUCTIONS: Use 8 1/2" x 11" white paper for attachments. Present original and one copy to address in upper right corner of this form. Please TYPE or PRINT. Please visit our office on the web at: www.sos.in.gov.

TODD ROKITA SECRETARY OF STATE CORPORATIONS DIVISION 302 W. Washington St., Rm. E018 Indianapolis, IN 46204 Telephone: (317) 232-6576 Indiana Code 23-17-22-3

FILING FEE IS $30.00

ARTICLES OF DISSOLUTION OF A DOMESTIC NONPROFIT CORPORATION
The undersigned officer of the Indiana Nonprofit Corporation named in Article I below (hereinafter referred to as the "Corporation") desiring to give notice of corporate action effectuating the dissolution of the Corporation pursuant to the provisions of the Indiana Nonprofit Corporation Act of 1991 (hereinafter referred to as the "Act"), certifies the following facts: ARTICLE I - CORPORATE NAME Name of Corporation ARTICLE II - DATE OF INCORPORATION Date of Incorporation ARTICLE III - AUTHORIZATION Dissolution was authorized (pursuant to Indiana Code 23-17-22-2) on ________________________________ , 20 ________ . ARTICLE IV - APPROVAL OF BOARD OF DIRECTORS Dissolution was approved by a sufficient vote of the Board of Directors. Yes No ARTICLE V - APPROVAL OF MEMBERS IF APPROVAL OF MEMBERS WAS NOT REQUIRED: Dissolution was approved by a sufficient vote of the Board of Directors or incorporators. Yes No Dissolution was approved by a person other than the members, and that approval pursuant to Indiana Code 23-17-22-2 (b) (3) was obtained. Yes No IF APPROVAL OF MEMBERS WAS REQUIRED, A OR B MUST BE COMPLETED: A. VOTES CAST FOR OR AGAINST DISSOLUTION TOTAL MEMBERS OR DELEGATES ENTITLED TO VOTE AS A CLASS 1 MEMBERS OR DELEGATES ENTITLED TO VOTE MEMBERS OR DELEGATES VOTED IN FAVOR MEMBERS OR DELEGATES VOTED AGAINST MEMBERS OR DELEGATES ENTITLED TO VOTE AS A CLASS 1 MEMBERS OR DELEGATES ENTITLED TO VOTE TOTAL NUMBER OF UNDISPUTED VOTES IN WITNESS WHEREOF, the undersigned being the _______________________ of the Corporation executes these Articles of Dissolution and
(Title)

2

3

B. FOR USE WHERE VOTES ARE UNDISPUTED

TOTAL

2

3

verifies, under penalties of perjury, that the statements herein are true, this __________ day of ______________________ , 20 _________. Signature Printed name

NOTE: Notice of Voluntary Dissolution must be filed with the following State agencies: the Unclaimed Property Section of the Attorney General of Indiana (IC 32-9-1-14); the Department of Revenue (IC 6-8.1-10-8); and the Indiana Department of Workforce Development (IC 22-432-22). Clearances from these agencies are no longer necessary. Indiana Department of Revenue Compliance Division 100 N. Senate Ave., Room N203 Indianapolis IN 46204 Telephone: (317) 232-2118 Indiana Department of Workforce Development Employer Audit Section 10 N. Senate Ave. Indianapolis IN 46204 Telephone: (317) 232-7436 Indiana Attorney General Unclaimed Property Section 402 W. Washington St., 5th Floor Indianapolis, IN 46204 Telephone: (317) 232-6348