Contact Information
KANSAS SECRETARY OF STATE
CP
Kansas Secretary of State
Certificate of Dissolution prior to Commencing Business
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
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Print
Please complete the form, print, sign and
mail to the Kansas Secretary of State with
the filing fee. Selecting 'Print' will print
Name of the corporation:
the form and 'Reset' will clear the entire
form.
Name must match the name on record with the secretary of state
The business or activity for which the corporation was organized has
Do not write in this space
not begun.
No part of the capital of the corporation has been paid, or if some capital has been paid, that the amount actually paid in for the
corporation’s shares, less any part thereof disbursed for necessary expenses, has been returned to those entitled to it.
All issued stock certificates, if any, have been surrendered and cancelled.
All rights and franchises of the corporation are hereby surrendered.
I/We declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct.
Executed on the ________ of ___________ , _____________
in accordance with K.S.A. 17-6803.
Day
Month
Year
By a majority of directors or incorporators:
Signed by a majority of directors or incorporators:
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
Instruction
Submit this form with the $35 filing fee.
Notice: There is a $25 service fee for all returned checks.
Rev. 12/06/04 jls
Rev. 8/11/03 amc
K.S.A. 17-6803