Free Verified Claim Form - Wyoming

File Size: 14.7 kB
Pages: 1
Date: February 27, 2007
File Format: PDF
State: Wyoming
Category: Secretary of State
Author: abyrne
Word Count: 82 Words, 765 Characters
Page Size: Letter (8 1/2" x 11")

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Date: ______________________ To: Wyoming Secretary of State's Office 200 West 24th Street, Suite 110 Cheyenne, WY 82002-0020 _______________________________________
(Name of entity)


Dear Secretary of State: The above entity is requesting a refund in the amount of $ Annual Report.

for the
(dollar amount)

The reason for requesting the refund is as follows:

Signature: _________________________________ Title: _____________________________________

State of Wyoming County of ______________________________ The foregoing instrument was acknowledged before me by __________________________________, this _______ day of _________________ , ______. Witness my hand and official seal. ____________________________ Notary Public SEAL