Notification Of Dissolution Or Surrender Form - Ohio Department Of Taxation

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D5
Rev. 4/02
Dissolution Unit
P.O. Box 182382
Columbus, OH 43218-2382
Notification of Dissolution or Surrender
See instructions on pages 4 and 5 of this form before completing. Please return this completed form D5 to the address shown
above. Do not send this D5 form to the Ohio Secretary of State’s office.
Part I – General information to be completed by all corporate taxpayers.
Part II – To be completed by those persons who intend to use the “certificate method” to dissolve the corporation’s Ohio
charter or surrender its Ohio license (see instructions).
Part III – To be completed by those persons who intend to use the “affidavit method” to dissolve the corporation’s Ohio
charter or surrender its Ohio license (see instructions).
Part I – General Information
Name of corporation
(as recorded with the Ohio Secretary of State)
Address
Date of incorporation or qualification
Ohio charter (license) number
Ohio franchise tax I.D. no.
State of incorporation
Type of corporation:
For-profit
Federal identification number
Not-for-profit
Cooperative (under Ohio Revised Code [R.C.]chapter 1729)
Location of accounting records
Name, address and telephone number of person to whom inquiries may be made
Telephone number
Date Ohio business activity ceased or will cease
Date stock retired or will be retired
Type of business activity and product sold
(If foreign corporation that will continue existence, indicate N/A.)
The last personal property tax return was filed on
in
(County)
(Date)
Ohio corporation franchise taxes have been filed and paid through
(Year)
Was a combined franchise tax report filed for any tax year after 1971?
Yes
No
If yes, list parent corporation’s name, Ohio charter number and Ohio franchise tax I.D. number
Ohio employer withholding tax returns have been filed through
(Month/year)
If none filed, explain
List All Tax Account Numbers (Vendor’s License,
Address of All Business Locations in Ohio
Seller’s Use, Consumer’s Use, Direct Pay, Fuel Use)
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