Wyoming Secretary of State
State Capitol Building, Room 110
th
200 West 24
Street
For Office Use Only
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Fax 307.777.5339
Email: business@state.wy.us
Profit Corporation
Application for Certificate of Reinstatement Following Administrative Dissolution
A corporation administratively dissolved under W.S. 17-16-1421 may apply to the Secretary of State for
reinstatement within two (2) years after the effective date of dissolution.
1. Corporation name:
2. Effective date of its administrative dissolution:
(Date – mm/dd/yyyy)
3. Grounds for dissolution have been eliminated.
4. Corporation’s name satisfies the requirements of W.S. 17-16-401.
Signature: ___________________________________________
Date:
(May be executed by Chairman of Board, President or another of its officers.)
(mm/dd/yyyy)
Print Name:
Title:
Contact Person:
Daytime Phone Number:
Email:
Checklist
Check one box only:
(a) Failure to file annual report - if the corporation was administratively dissolved for failure to file
its annual report and pay the annual license tax, all delinquent reports must accompany this form along
with the $50.00 reinstatement fee and taxes for each delinquent report.
(b) Failure to maintain registered agent – if the corporation was administratively dissolved for
failure to maintain a registered agent, the reinstatement fee is $250.00 and payment of any fees and
taxes then delinquent.
Make check or money order payable to Wyoming Secretary of State.
Please submit one originally signed document and one exact photocopy of the filing.
Please review form prior to submitting to the Secretary of State to ensure all areas have been
completed to avoid a delay in the processing of your documents.
P-CertificateReinstatement-AdminDissolution – 07/01/2010