Form Nw 53-01 - Not For Profit Corporation Dissolution By Written Consent - Kansas Secretary Of State

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Fees will increase September 1, 2003. If you file this report
before September 1, the fee is $20.00. If you file this report after
September 1, the fee is $35.00.
Contact Information
KANSAS SECRETARY OF STATE
NW
Kansas Secretary of State
Not For Profit Corporation Dissolution by Written Consent
Ron Thornburgh
53-01
Memorial Hall, 1st Floor
All information must be completed or this document will not be accepted for filing.
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
Print
Reset
1. Name of the corporation:
Please complete the form, print, sign and
mail to the Kansas Secretary of State with
__________________________________________________
the filing fee. Selecting 'Print' will print the
__________________________________________________
form and 'Reset' will clear the entire form.
Name must match the name on record with the secretary of state
2. All the members with voting power do hereby consent to the
dissolution of the corporation.
Do not write in this space
Members’ Signatures
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
Officers:
Name
Title
Address
City
State
Zip
Directors:
Name
Address
City
State
Zip
I, ________________________________________________ , declare under penalty of perjury under the laws of the state of
Name of officer
Kansas, that I am an officer in the above-named corporation, that the above consent has been signed by or on behalf of ALL members
entitled to vote on the dissolution, and that the foregoing is true and correct.
Executed on the ________ of ___________ , _____________
.
Day
Month
Year
Officer’s signature
Instructions
1. If this form is submitted after the close of the corporation’s tax year, an annual report and franchise tax
must be submitted for that year. If the corporation has forfeited, it must reinstate before dissolution.
2. Submit this form in duplicate with the $35 filing fee.
Notice: There is a $25 service fee for all returned checks.
K.S.A. 17-6804, 6805
Rev. 8/11/03

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