Form Dw 53-01 - For-Profit Corporation Dissolution By Written Consent

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KANSAS SECRETARY OF STATE
DW
For-Profit Corporation Dissolution
53-01
by Written Consent
Kansas Secretary of State, Chris Biggs
CONTACT:
Memorial Hall, 1st Floor
(785) 296-4564
120 S.W. 10th Avenue
Topeka, KS 66612-1594
Above space is for office use only.
All information must be completed or this document will not be accepted for filing.
INSTRUCTIONS:
i
Please read instructions before completing.
1. Business entity ID
number:
This is not the Federal Employer
ID Number (FEIN)
_______________________________________
2. Name of corporation:
Name must match the name on
record with the Secretary of State
________________________________________________________________________________________
3. Name and mailing
1)
address of each officer:
______________________________________________________________________________________
Do not leave blank
Name
If additional space is needed
_______________________________________________________________________________________
please provide an attachment
Mailing address
City
State
Zip
Country
2)
______________________________________________________________________________________
Name
__________________________________________________________________________________________
Mailing address
City
State
Zip
Country
3)
_____________________________________________________________________________________
Name
____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Mailing address
City
State
Zip
Country
4. Name and mailing
address of the board of
1) ______________________________________________________________________________________
directors:
Name
Do not leave blank
_______________________________________________________________________________________
If additional space is needed
Mailing address
City
State
Zip
Country
please provide an attachment
______________________________________________________________________________________
2)
Name
__________________________________________________________________________________________
Mailing address
City
State
Zip
Country
_____________________________________________________________________________________
3)
Name
____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Mailing address
City
State
Zip
Country
Page 1 of 2
Rev. 6/01/10 nr
K.S.A . 17-6804

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