Form 651 - Certificate Of Termination Of A Domestic Entity Page 4

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651
Form
(Revised 09/09)
Return in duplicate to:
Secretary of State
P.O. Box 13697
Certificate of Termination
Austin, TX 78711-3697
512 463-5555
of a
FAX: 512 463-5709
Domestic Entity
Filing Fee: $40
Entity Information
1. The name of the domestic entity is:
2. The entity is organized as a
under the laws of Texas.
e.g., for-profit corporation, limited partnership, etc.
3. The date of formation of the entity is:
4. The file number issued to the filing entity by the secretary of state is:
Governing Persons
5. The names and addresses of each of the filing entity’s governing persons are:
(see instructions)
NAME AND ADDRESS OF GOVERNING PERSON
(Enter the name of either an individual or an organization, but not both.)
IF INDIVIDUAL
First Name
M.I.
Last Name
Suffix
OR
IF ORGANIZATION
Organization Name
Street or Mailing Address
City
State
Country
Zip Code
NAME AND ADDRESS OF GOVERNING PERSON
(Enter the name of either an individual or an organization, but not both.)
IF INDIVIDUAL
First Name
M.I.
Last Name
Suffix
OR
IF ORGANIZATION
Organization Name
Street or Mailing Address
City
State
Country
Zip Code
Form 651
4

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