Form Cd-5-Statement Of Intent To Dissolve A West Virginia Corporation June 1999
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1
2JOE MANCHIN, III
Penney Barker, Supervisor
STATEMENT OF INTENT TO DISSOLVE
Secretary of State
Corporations Division
Bldg. 1, Rm 157-K
A WEST VIRGINIA CORPORATION
Tel. (304) 558-8000
1900 Kanawha Blvd. East
Fax (304) 558-0900
Charleston, WV 25305-0770
Hours: 8:30 am - 4:30 pm ET
FILE DUPLICATE ORIGINALS
No fee until Articles of Dissolution filed
The undersigned for-profit West Virginia corporation submits the following statement of intent to dissolve a West Virginia
corporation, according to he provisions of West Virginia Code 31-1-125 or 31-1-126.
The name of the corporation is:
1.
The mailing address to which correspon-
2.
dence relating to this matter should be
addressed is:
[NOTE: Dissolution procedures
may take some time. Please use an address
expected to remain in use.]
3.
The names and addresses of the officers of the corporation are:
[Use additional page if necessary]
President
Vice Pres.
Secretary
Treasurer
4.
The names and address of the directors of the corporation are:
[Use additional page if necessary]
Execution: [Two original statements of intent with original attachments required]
We, the undersigned president (or vice president) and secretary (or assistant secretary) confirm that this statement of intent
to dissolve is based upon: [Check one and provide information required]
the attached written consent of all its shareholders [ 31-1-125] signed by all shareholders of the corporation or signed in
their names by their attorneys thereunto.
[Form on reverse may be used.]
the attached resolution authorizing the dissolution of the corporation adopted by an affirmative vote of a majority of
holders of shares of the corporation [ 31-1-126], and the record of the vote of all outstanding shares and classes of
shares is included therein:
[Form on reverse may be used.]
President/Vice Pres. Name (type or print)
Signature
Date
Secretary/Asst. Sec. Name (type or print)
Signature
Date
Verification: [The signature of at least one of the above officers must be notarized.]
State of _______, County of __________: The foregoing instrument was acknowledged before me this day of ______________, by
___________________of _________________, a WV corporation, on
behalf of the corporation.
_______________________________________________________
Notary Public
(Notary Seal) My commission expires______________________
FORM CD-5
Issued by the Secretary of State, State Capitol, Charleston, WV 25305-0770
Revised 6/99
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