Free Microsoft Word - ST-CertificateReinstatement - Wyoming

Wyoming Secretary of State
State Capitol Building, Room 110 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: [email protected]

For Office Use Only

Statutory Trust Application for Certificate of Reinstatement
A statutory trust administratively dissolved under W.S. 17-23-111 may apply to the Secretary of State for reinstatement within two (2) years after the effective date of dissolution. 1. Statutory trust company name:

2. Effective date of its administrative dissolution:
(Date ­ mm/dd/yyyy)

3. Grounds for dissolution have been eliminated.

Signature: ___________________________________________
(Shall be signed by an authorized individual)

Date:
(mm/dd/yyyy)

Print Name: Title: Contact Person: Daytime Phone Number: Email: Checklist Filing Fee: If the Statutory Trust was administratively dissolved for failure to file its annual report and pay the annual license tax, all delinquent reports must accompany this form along with the $100.00 reinstatement fee and double taxes for each delinquent report ($200 per report). Make check or money order payable to Wyoming Secretary of State. Please submit one originally signed document and one exact photocopy of the filing. Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in the processing of your documents.

ST-CertificateReinstatement ­3/23/2009