Statement Form Of Dissolution Of Delinquent Entity
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1
2Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Statement of Dissolution of Delinquent Entity
filed pursuant to § 7-90-908 of the Colorado Revised Statutes (C.R.S.)
1. The entity ID number and the entity name of the delinquent entity are
Entity ID number
__________________________
(Colorado Secretary of State ID number)
Entity name
______________________________________________________.
2. The principal office address of such entity’s principal office is
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
3.
(The following statement is adopted by marking the box.)
The entity is delinquent and has failed to cure its delinquency for three years or more.
4.
(The following statement is adopted by marking the box.)
At least thirty days prior to the delivery of the Statement of Dissolution of Delinquent Entity to the
Secretary of State, the delinquent entity delivered written notice of the delinquent entity’s plan to file
a Statement of Dissolution of Delinquent Entity to all owners and other persons having authority under
the organic statutes and under its constituent operating document to bring about or prevent dissolution of
the entity and the delinquent entity has not received, as of the date the Statement of Dissolution of
Delinquent Entity is delivered for filing to the Secretary of State, written objections to dissolution from
such number of such owners and other persons as would be sufficient to prevent voluntary dissolution of
the delinquent entity under the organic statutes and its constituent operating document.
5.
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains additional information as provided by law.
6.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant
legal consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document are ___________________________.
(mm/dd/yyyy hour:minute am/pm)
DISS_DLQ
Page 1 of 2
Rev. 2/26/2008
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