Form F0022 - Application For Reinstatement Following Administrative Dissolution/revocation - 1996 Page 2

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F0022 - Page 2 of 2
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136
(601) 359-1333
*0022-2-2*
Request for Certification
1. Name of Corporation
2. Street Address
-
City, State, ZIP5, ZIP4
3. Incorporated in the State of
4. Federal Tax ID Number
This is to request certification from the Mississippi State Tax Commission that all taxes owed by
this corporation have been paid.
Name of Corporation
(Please keep writing within blocks)
By:
Signature
Printed Name
Title
Please send this form directly to:
MISSISSIPPI STATE TAX COMMISSION
PO BOX 1033
JACKSON, MS 39215

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