Form Dc-11 - Statement Of Intent To Dissolve 2001
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1FORM DC-11
B
R
WWW.
USINESS
1/2001
Nonrefundable Filing Fee: $50.00
STATE OF HAWAII
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
Business Registration Division
1010 Richards Street
Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810
Clear Form
STATEMENT OF INTENT TO DISSOLVE
(Section 415-83 and -84, Hawaii Revised Statutes)
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK
The undersigned, duly authorized officers of the corporation submitting this Statement, certify as follows:
1.
The name of the corporation is:
_________________________________________________________________________________________________
2.
Attached is a list of the names, office held, and addresses of all of the officers and directors of the corporation.
3.
The resolution approving the dissolution was adopted (check one):
at a meeting of the shareholders held on
____________________________________________________________________ .
(Month
Day
Year)
Total Number of Shares
Number of Shares Voting For
Number of Shares Voting
Class/Series
Outstanding
Resolution
Against Resolution
OR
by written consent dated
which all of the shareholders signed.
__________________________________________________
(Month
Day
Year)
We certify under the penalties of Section 415-136, Hawaii Revised Statutes, that we have read the above statements and that
the same are true and correct.
Signed this ____________day of ___________________________________, __________
_______________________________________________________
_________________________________________________________
(Type/Print Name & Title)
(Type/Print Name & Title)
_______________________________________________________
_________________________________________________________
(Signature of Officer)
(Signature of Officer)
SEE INSTRUCTIONS ON REVERSE SIDE. The statement must be signed by two individuals who are officers of the
corporation.
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