Form For A Certificate Of Dissolution
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1
2New York State
Department of State
Division of Corporations, State Records
and Uniform Commercial Code
Albany, NY 12231
CERTIFICATE OF DISSOLUTION
OF
(Insert corporate name)
Under Section 1003 of the Business Corporation Law
FIRST:
The present name of the corporation is:
(If the name of the corporation has been changed, the name under which it was formed is:
.)
SECOND:
(must include month, day and year)
The certificate of incorporation was filed by the Department of
State on:
THIRD:
(must include number and street)
The name and addresses of each officer and director of the
corporation is:
FOURTH:
The corporation elects to dissolve.
FIFTH:
(check appropriate box)
9
The dissolution was authorized at a meeting of shareholders by a vote of two-thirds of all
outstanding shares entitled to vote or by the unanimous written consent of the holder(s) of all
outstanding shares entitled to vote and the certificate of incorporation does not provide for an
alternate manner of authorization.
9
The dissolution was authorized in the manner required by provisions in the certificate of
incorporation.
Document must be signed on reverse side.
DOS-1337 (Rev. 8/98)
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