Not For Profit Corporation Dissolution By Written Consent Form - Kansas Secretary Of State
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1Contact Information
KANSAS SECRETARY OF STATE
NW
Kansas Secretary of State
Not For Profit Corporation Dissolution by Written Consent
Ron Thornburgh
53-13
Memorial Hall, 1st Floor
All information must be completed or this document will not be accepted for filing.
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
Print
Reset
Please complete the form, print, sign and
1. Name of the corporation:
mail to the Kansas Secretary of State with
__________________________________________________
the filing fee. Selecting 'Print' will print the
__________________________________________________
form and 'Reset' will clear the entire form.
Name must match the name on record with the secretary of state
2. All the members with voting power do hereby consent to the
dissolution of the corporation.
Do not write in this space
Members’ Signatures
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
Officers:
Name
Title
Address
City
State
Zip
Directors:
Name
Address
City
State
Zip
I, ________________________________________________ , declare under penalty of perjury under the laws of the state of
Name of officer
Kansas, that I am an officer in the above-named corporation, that the above consent has been signed by or on behalf of ALL members
entitled to vote on the dissolution, and that the foregoing is true and correct.
Executed on the ________ of
___________
, _____________
.
Day
Month
Year
Officer’s signature
Instructions
1. Submit this form with the $20 filing fee.
2. If this form is submitted after the close of the corporation’s tax year, an annual report and franchise tax
must be submitted for that year.
Notice: There is a $25 service fee for all returned checks.
K.S.A. 17-6804, 6805
Rev
. 4/05/04 amc
Rev. 12/07/04 jls
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