Certificate of Dissolution of a Non-profit Corporation by Trustees (Ohio)
This form is for Dissolution by Trustees of a Non-profit Corporation in Ohio. The form provided here is simply a basic structure for the actual form you will fill in to dissolve a non-profit corporation.
Prescribed by J. Kenneth Blackwell
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)
CERTIFICATE OF DISSOLUTION BY TRUSTEES OF
FIRST: ______________________ (Exact Name of Corporation)
____________________ (Charter Number)
____________________ (name), who is ________________ (title) of the above named Ohio not for profit corporation, articles of incorporation of which were filed in the office of the Secretary of State on ___________________ do hereby certify that:
SECOND: The place where its principal office in Ohio is or is to be located is
________________________ (city, township, or village), Ohio _________________ (county)
THIRD: The names and complete street addresses of the TRUSTEES are: (A P.O. Box address cannot be accepted.)
NAME _______________________________
STREET _____________________________
CITY________________________________
STATE _______________
ZIP CODE ____________
NAME _______________________________
STREET _____________________________
CITY________________________________
STATE _______________
ZIP CODE ____________
FOURTH: The names and complete street addresses of the OFFICERS are: (A P.O. Box address cannot be accepted.)
NAME _______________________________
STREET _____________________________
CITY________________________________
STATE _______________
ZIP CODE ____________
NAME _______________________________
STREET _____________________________
CITY________________________________
STATE _______________
ZIP CODE ____________
FIFTH: The name and Ohio address of the statutory agent is
___________________________ (name)
___________________________ (street and number) (A P.O. Box address cannot be accepted)
___________________________ (city, village or township), Ohio
____________ (zip code)
NOTE: IF the statutory agent listed in item "FIFTH" has changed or differs from the agent currently appearing on the corporate records in the Secretary of State's office, the named agent must acknowledge and accept the appointment as statutory agent.
ACCEPTANCE OF APPOINTMENT
The undersigned, _______________________, named herein as the statutory agent for the corporation named herein, hereby acknowledges and accepts the appointment as statutory agent for said corporation.
________________________ (Signature of Statutory Agent)
SIXTH: The undersigned have been authorized to execute and file this certificate by a resolution of the Trustees adopted pursuant to Section 1702.47 (C) (_______) (must insert proper para. #) of the Revised Code:
(Check one of the following)
___ at a meeting duly called and held on ____________________
___ in writing signed by all of the trustees pursuant to Section 1702.47 of the Revised Code, declaring that the corporation elects to wind up its affairs and dissolve.
IN WITNESS WHEREOF, the above signed officer acting for and on behalf of the corporation have hereunto subscribed his/her names on ____________ (date)
Signature: ________________________ (Authorized Officer)
Name: __________________________
AFFIDAVIT
In lieu of dissolution releases from various governmental authorities (1702.47(G)(5) O.R.C.)
__________________________ (Exact Name of Corporation)
The undersigned, being first duly sworn, declares that on the dates indicated below, each of the named state governmental agencies was advised IN WRITING of the scheduled date of filing of the Certificate of Dissolution and was advised IN WRITING of the acknowledgement by the corporation of the applicability of the provisions of Section 1702.47 of the Ohio Revised Code.
AGENCY
1. Ohio Department of Taxation
Dissolution Section
Box 182382
Columbus, Ohio 43218-2382
DATE NOTIFIED _______________
2. Ohio Bureau of Employment Services
Status & Liability Section
145 S. Front St.
Columbus, Ohio 43215
DATE NOTIFIED _______________
3. The treasurer of any County named below:
___________________________
___________________________
___________________________
DATE NOTIFIED _______________
Note: This affidavit must be signed by one or more persons executing the certificate of surrender or by an officer of the corporation.)
Signature: ___________________________
Title: ________________________________
Name: _______________________________
Address: ____________________________
City: ________________________________
State: ___________
Zip: ____________
Sworn before me and subscribed in my presence on ____________ (date)
____________________________ (Notary Public)
(Notary Seal)
Commission expires ________________ (date)
AFFIDAVIT OF PERSONAL PROPERTY
STATE OF OHIO
COUNTY OF ___________________ :SS
__________________________, being first duly sworn, deposes and says that she/he is ________________________ (title) of ____________________, that this affidavit is made in compliance with section _______ (Section #) of the Ohio Revised Code;
That said corporation has: (Check one of the following)
___ personal property only in the following county(ies)
__________________________,
__________________________
___ has no personal property in any county in the State of Ohio:
and that the net assets of said corporation are sufficient to pay all personal property taxes accrued to date.
Signature: _______________________________
Name: __________________________________
Sworn before me and subscribed in my presence on ____________ (date)
____________________________ (Notary Public)
(Notary Seal)
Commission expires ________________ (date)
(Section #)