Form Dw 53-01 - 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
DW
Kansas Secretary of State
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
Please complete the form, print, sign and
Name of the corporation:
mail to the Kansas Secretary of State with
__________________________________________________
the filing fee. Selecting 'Print' will print
Name must match the name on record with the secretary of state
the form and 'Reset' will clear the entire
form.
All the stockholders with voting power do hereby consent to the
dissolution of the corporation.
Do not write in this space
Stockholders’ 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 Kansas,
Name of officer
that I am an officer of the above-named corporation, that the above consent has been signed by or on behalf of ALL stockholders
entitled to vote on the dissolution, and that the foregoing is true and correct.
Executed on the ________ of ___________ , ___________
.
Day
Month
Year
__________________________________________
Signature of Secretary or other Officer
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.
Rev. 8/11/03 amc
K.S.A. 17-6804

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