Form 05-359 Request For Certificate Of Account Status To Terminate A Taxable Entity'S Existence In Texas

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05-359

(rev.7-08/9)

PRINT FORM

CLEAR FIELDS

REQUEST FOR CERTIFICATE OF ACCOUNT STATUS

TO TERMINATE A TAXABLE ENTITY’S EXISTENCE IN TEXAS

ATTENTION: An entity that intends to dissolve or otherwise end its legal existence must be current with tax filing requirements for all taxes administered

by the Comptroller under Title 2 of the Texas Tax Code and all tax accounts for those taxes must be closed. To determine if the entity is current in tax re-

quirements and to close any open tax accounts, call toll free (800) 252-1381 from anywhere in the United States. The Austin number is (512) 463-4600.

SECTION A - ENTITY INFORMATION

Legal entity name

Taxpayer number

File number (From the Texas Secretary of State)

1. Is this entity a member of an affiliated group that will be required to file a combined report? .....................................................

yes

If the answer is “YES,” enter the following information for the entity that will report on your behalf. If the answer is “NO,” skip to Section B.

Legal name of REPORTING ENTITY

Texas taxpayer number / FEI number

2. is this entity’s accounting period beginning date on or after the accounting period

beginning date to be used by the combined group on its franchise tax report? ...........................................................................

yes

If the answer is “YES,” this entity’s information MUST be included in the combined group report. If the answer is “NO,” enter the following information.

This entity’s

The day before the

month

day

year

month

day

year

accounting period

accounting period beginning

beginning date .....................................

date of the combined group .................

SECTION B - TEXAS ENTITY

If the entity is formed in Texas, indicate the filing for which the certificate is required:

DissoLuTion / TerminaTion

merger

enTiTy conversion

SECTION C - NON-TEXAS ENTITY

If the entity is formed outside of Texas, please complete the following information:

1. is the entity still conducting business in Texas? ..........................................................................................................................

yes

2. If “NO,” enter the last day of business activity in Texas: ____________________________________________________________________________

3. Does the entity still have an active charter in its home state? ....................................................................................................

yes

4. If “NO,” please indicate how the home state charter was terminated and the effective date:

month

day

year

Dissolution effective date: ...............................

Merger effective date: ......................................

Name of survivor: ____________________________________

Entity conversion effective date: ......................

NOTE: If the home state charter has been terminated, a copy of the home state documentation evidencing that the entity ceased to exist must accom-

pany this request. The home state documentation must bear the seal of the Secretary of State or other appropriate filing agency and the effective date

of the filing.

SECTION D - CERTIFICATE INFORMATION

The Secretary of State offers filing of dissolutions and withdrawals through the SOSDirect System, on-line at

To assist you in filing these forms you can request the Certificate of Account Status in electronic (.pdf) format. Fax is also available for your convenience.

Please note that all requests are processed in the order received, regardless of the format you select.

Please indicate how you would like to receive your certificate.

FaX number

Telephone number

FaX

(Area code and number): _______________________________ (Area code and number): _________________________________

.PDF

E-mail address: _____________________________________________________________________________________________

Mail

Mailing address: ______________________________________ City: _____________________ State: ______ ZIP code: _________

Requestor name (Please type or print)

Telephone number & extension

authorized agent

FOR ASSISTANCE: If you have any questions regarding franchise tax, you may contact

Mail to: COMPTROLLER OF PUBLIC ACCOUNTS

the Texas State Comptroller’s field office in your area or call (800) 252-1381, toll free,

P.O. Box 149348

nationwide. The Austin number is (512) 463-4600.

austin, Texas 78714-9348

Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance with Ch. 552, Govern-

ment Code. To request information for review or to request error correction, contact us at the address or toll-free number listed on this form.