Y Information For Consent To Dissolution Form Nyc Finance

NYC DEPARTMENT OF FINANCE

COLLECTION DIVISION

G

REQUEST FOR SUPPLEMENTARY INFORMATION

TM

Finance

FOR CONSENT TO DISSOLUTION

Instructions: Mail completed and signed application with copies of required documents to:

NYC Department of Finance, Collection Division, Quality Management/Special Project, 59 Maiden Lane, 28th Floor, New York, NY 10038.

BUSINESS INFORMATION

__________________________________________________

_________________________________

Corporation Name

Taxpayer Identification Number

Name of Party

Completing This Form: ___________________________________________________________________

FIRST NAME

LAST NAME

Telephone

Email

Number: (_______) __________________________

Address: __________________________________

Nature of Business (provide a brief description): __________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

RETURN INFORMATION

Please complete the following if the corporation has done business in New York City. Note: If you checked “YES” and did file a return,

you must attach a copy with this application. If you checked “NO” and did not file a return for the years you did business in New York

City, you must submit a return. Visit the Finance website at nyc.gov/finance to obtain appropriate forms or call 311.

___________________________________________________________________________________________________________________________________________________________________________________

LIST YEARS DOING BUSINESS IN NYC

DATE BUSINESS ENDED IN NYC

A RETURN WAS FILED

From _______________ To ____________________________________________

YES

NO

K

K

-

-

MM

DD

YYYY

From _______________ To ____________________________________________

YES

NO

K

K

-

-

MM

DD

YYYY

From _______________ To ____________________________________________

YES

NO

K

K

-

-

MM

DD

YYYY

From _______________ To ____________________________________________

YES

NO

K

K

Check this box if this corporation did NOT conduct business in New York City in any year.

K

Note: if the corporation did not conduct business in New York City, no City consent to dissolution is required.

SIGNATURE AND DATE

_________________________________________

_________________________________________

Print or Type Name of Signer

Print or Type Title of Signer

/

/

_________________________________________

________________________

________________________

________________________

Signature

Date

Dissolution Consent Request - Rev. 01.07.2014