Statement Under Section 1703.17 Form printable pdf download

Statement Under Section 1703.17 Form

J. Kenneth Blackwell

Prescribed by

Please obtain fee amount and mailing instructions from the Forms

Inventory List (using the 3 digit form # located at the bottom of this

form). To obtain the Forms Inventory List or for assistance, please

call Customer Service:

Central Ohio: (614)-466-3910 Toll Free: 1-877-SOS-FILE (1-877-767-3453)

STATEMENT UNDER SECTION 1703.17

Pursuant to the provisions of Section 1703.1 7 of the Revised Code of Ohio,

a corporation organized under the laws of the state of

states that the address to which the Secretary

of State may mail any process against such corporation that may be served upon him, and may mail any other notices, certificates,

or statements is

(street address)

(city, township, or village)

(state)

(zip code)

(Name of Corporation)

Signature:

Name:

Title:

NOTE:

This certificate must accompany a certificate of certified copy of dissolution, merger, consolidation, or

court order terminating the existence of the corporation submitted in lieu of a certificate of surrender of license.

164-1703-17

Page 1 of 1

Version: 7/15/99

Statement Under Section 1703.17 Form