Form 651 - Certificate Of Termination Of A Domestic Entity Page 6

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C.
This document takes effect upon the occurrence of the future event or fact, other than the
th
passage of time. The 90 day after the date of signing is:
The following event or fact will cause the document to take effect in the manner described below:
Tax Certificate
(Required)
Attached hereto is a certificate from the comptroller of public accounts that all taxes under title 2,
Tax Code, have been paid.
Execution
The undersigned signs this document subject to the penalties imposed by law for the submission of a
materially false or fraudulent instrument and certifies under penalty of perjury that the undersigned is
authorized under the provisions of law governing the entity to execute the filing instrument.
Date:
:
By
A person authorized by law to execute the filing instrument
(see instructions)
Printed or typed name of authorized person
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