Form Dsf Stk - Short Form Dissolution Certificate - 2016 Page 6
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6DSF STK
Secretary of State
Short Form Dissolution Certificate
(ONLY California Stock Corporation Registered in
California in the Last 12 Months)
IMPORTANT —
Read Instructions
before completing this form.
There is No Fee for filing a Short Form Dissolution Certificate - Stock
Copy Fees – First page $1.00; each attachment page $0.50;
Certification Fee - $5.00 plus copy fees
This Space For Office Use Only
1. Corporate Name
2. 7-Digit Secretary of State File Number
(Enter the exact name of the corporation as it is recorded
with the California Secretary of State.)
3. Required Statements
(Do not alter the Required Statements – ALL must be true to file Form DSF STK.)
Statements 3(a) – 3(g) are true:
a)
This Short Form Certificate of Dissolution is being filed within twelve (12) months from the date the Articles of Incorporation
were filed with the Secretary of State;
b)
The corporation does not have any debts or other liabilities, except as provided in Item 3(c);
c)
The tax liability of the corporation will be satisfied on a taxes paid basis, or a person or corporation or other business entity
assumes the tax liability, if any, of the dissolving corporation and is responsible for additional corporate taxes, if any, that are
assessed and that become due after the date of the assumption of the tax liability;
d)
All final returns required under the California Revenue and Taxation Code have been or will be filed with the California
Franchise Tax Board;
e)
The corporation has not conducted any business from the time of the filing of the Articles of Incorporation with the Secretary
of State;
f)
The corporation has not issued any shares, and if the corporation has received payments for shares from investors, those
payments have been returned to those investors;
The corporation is dissolved; and
g)
h)
The known assets remaining after payment of, or adequately providing for, the known debs and liabilities have been
distributed to the persons entitled thereto; or the corporation acquired no known assets.
Note: If the corporation cannot say all of these items are true, the corporation cannot file this Short Form Dissolution Certificate (Form
DSF STK) and must follow the normal dissolution process. See Certificate of Dissolution
(Form DISS
STK), and if applicable, Certificate
of Election to Wind Up and Dissolve
(Form ELEC
STK).
4. Dissolution
(Check the applicable statement. Only one box may be checked.)
The undersigned sole director or a majority of the directors now in office has authorized the dissolution and elected to
dissolve the corporation.
No directors were named in the original Articles of Incorporation and none have been elected. The undersigned sole
incorporator or a majority of the incorporators has authorized the dissolution and elected to dissolve the corporation.
Note: The second box cannot be checked if the corporation has filed a Statement of Information with the California Secretary of State.
5. Read, Verify, Date and Sign Below
(See Instructions
for signature requirements.)
I declare under penalty of perjury under the laws of the State of California that the matters set forth in this certificate are true and
correct of my own knowledge.
__________________
____________________________________________
______________________________________________
Date
Signature
Type or Print Name
__________________
__________________________________________
______________________________________________
Date
Signature
Type or Print Name
__________________
__________________________________________
______________________________________________
Date
Signature
Type or Print Name
2016 California Secretary of State
DSF STK (REV 12/2016)
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