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Nonprofit Corporation Application For Certificate Of Reinstatement Following Administrative Dissolution - Wyoming Secretary Of State

Secretary of State

State of Wyoming

The Capitol

Cheyenne, WY 82002-0020

NONPROFIT CORPORATION

APPLICATION FOR CERTIFICATE OF REINSTATEMENT

FOLLOWING ADMINISTRATIVE DISSOLUTION

A nonprofit corporation administratively dissolved under W.S. 17-19-1421 may apply to the secretary of

state for reinstatement within two (2) years after the effective date of dissolution.

The name of the corporation is: _____________________________________________________

The effective date of its administrative dissolution was: __________________________________

The grounds for dissolution have been eliminated.

The corporation’s name satisfies the requirements of W.S. 17-19-401.

Date: _________________________

Signed: ____________________________________

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Filing Fee: $10.00

The document may be executed by Chairman of Board, President or another of its officers.

If the corporation was administratively dissolved for failure to file its annual reports and pay

the annual license taxes, the delinquent reports must accompany this form along with double

the license tax for each delinquent year.

The document shall be accompanied by one (1) exact or conformed copy.

npreinad - Revised: 9/98

Nonprofit Corporation Application For Certificate Of Reinstatement Following Administrative Dissolution - Wyoming Secretary Of State