Form It-966 - Notice Of Corporate Dissolution Liquidation Or Withdrawal

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IT-966
NOTICE OF CORPORATE DISSOLUTION
SF# 50150
LIQUIDATION OR WITHDRAWAL
(R2 / 2-08)
(Required under IC 6-8.1-10-9)
Name of Corporation:
Employer Identifi cation Number:
Address:
Indiana Taxpayer Identifi cation Number:
City or Town, State and ZIP Code:
Type of Indiana Corporate Return fi led:
Date Incorporated:
Market value of Corporate Assets:
State of Incorporation:
Corporate Liabilities:
Type of Liquidation:
Last month, day & year of fi nal tax year:
Partial
Complete
Date of Dissolution:
Was corporation’s fi nal return fi led as part of a consolidated
income tax return?
Yes
No
Name of common parent:
Employer Identifi cation Number:
Date of any amendments to plan of dissolution:
Section of the Internal Revenue Code under which the corporation
is to be dissolved or liquidated:
Under the penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to
the best of my knowledge and belief, it is true, correct, and complete.
_______________________________________________
____________________________________
__________
Signature of Offi cer
Title
Date
Name/Address/Social Security Number of Corporate Offi cers/Directors/Shareholders. (Use additional sheets if Necessary.)
Name of Corporate Offi cial/Shareholder
Address of Corporate Offi cial/Shareholder
Social Security Number
The following information must be attached to this form:
(1) A copy of the minutes of the shareholders’ meeting at which the plan or resolution was formally adopted.
(2) A copy of the corporation’s certifi cate of dissolution or a copy of the corporation’s certifi cate of withdrawal.
(3) A complete explanation of the plan or resolution.
(4) A copy of the Final Corporate Returns, both Federal and State.

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