Articles Of Dissolution Of A Domestic Nonprofit Corporation
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ARTICLES OF DISSOLUTION OF A
CONNIE LAWSON
DOMESTIC NONPROFIT CORPORATION
SECRETARY OF STATE
CORPORATIONS DIVISION
State Form 39080 (R8 / 4-12) Corporate Form No. 364-5 (1-88)
302 W. Washington St., Rm. E018
Approved by State Board of Accounts, 1995
Indianapolis, IN 46204
T elephone: (317) 232-6576
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.
Indiana Code 23-17-22-3
Please TYPE or PRINT.
Please visit our office on the web at:
FILING FEE IS $30.00
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 (month, day, year)
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:
MEMBERS OR DELEGATES
ENTITLED TO VOTE AS A CLASS
A. VOTES CAST FOR OR AGAINST DISSOLUTION
TOTAL
1
2
3
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
B. FOR USE WHERE VOTES ARE UNDISPUTED
TOTAL
1
2
3
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)
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 22-4-
32-22). Clearances from these agencies are no longer necessary.
Indiana Department of Workforce Development
Indiana Department of Revenue
Indiana Attorney General
Employer Audit Section
Compliance Division
Unclaimed Property Section
100 N. Senate Ave., Room N203
10 N. Senate Ave.
402 W. Washington St., 5th Floor
Indianapolis IN 46204
Indianapolis IN 46204
Indianapolis, IN 46204
Telephone: (317) 232-2118
Telephone: (317) 232-7436
Telephone: (317) 232-6348
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