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Dissolution - 275 Short Form - Web - Dissolution - 275 Short Form - web

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Delaware Division of Corporations
401 Federal Street – Suite 4
Dover, DE 19901
Ph: 302-739-3073
Fax: 302-739-3812
Certificate of Dissolution
Short Form
Dear Sir or Madam:
Attached please find a form for a Certificate of Short Form Dissolution to be filed in
accordance with Section 275 and 391 (a) (5) (b) of the General Corporation Law of the State of
Delaware. The fee to file the Certificate is $10.00. You will receive a stamped “Filed” copy of your
submitted document. A certified copy may be requested for an additional $50. Expedited services are
available. Please contact our office concerning these fees or you may consult our fee chart at
www.corp.delaware.gov
.
Before the Certificate can be filed, all taxes due to the State through the effective date of the
dissolution must be paid and all applicable Annual Franchise Tax Reports must be filed. Please
contact the Franchise Tax Section prior to submitting the document for filing to determine the
Franchise Taxes and Annual Reports due. Please make your check payable to “Delaware Secretary of
State”.
For the convenience of processing your order in a timely manner, please include a cover
letter with your name, address and telephone/fax number to enable us to contact you if necessary.
Please make sure you thoroughly complete all information requested on this form. It is important that
the execution be legible, we request that you print or type your name under the signature line.
Thank you for choosing Delaware as your corporate home. Should you require further
assistance in this or any other matter, please don’t hesitate to call us at (302) 739-3073.
Sincerely,
Department of State
Division of Corporations
rev. 08/10
Special Instructions – Short Form Certificate of Dissolution
This form is to be used as a Template only. The following instructions
will help you in correctly completing your Dissolution Certificate. The
instructions will be numbered to correspond with the article it is
referencing.
1. The current name of the corporation exactly as it appears in our
records. Please visit our website to verify the name.
2. The date when the corporation was originally formed.
3. List the date the Dissolution was authorized by the Board of
Directors and Stockholders of the Corporation.
4. List the names, titles and addresses of all directors and officers of
the corporation. Please list complete addresses which include
street, number, city and zip code.
Execution Block - The document must be signed by an authorized
officer of the corporation pursuant to Section 103 of Title 8. The
name of the person must be typed or written legibly underneath the
signature.
This form contains information required by statute; if you need to add
additional information permitted by statute you may draft a new
document. Please feel free to call our office at 302-739-3073 for
assistance in completing this form.
Sincerely,
Delaware Division of Corporations
STATE OF DELAWARE
SHORT FORM CERTIFICATE
OF DISSOLUTION
(SECTIONS 275 AND 391 (a) (5) (b))
The corporation organized and existing under the General Corporation Law of the State of
Delaware, hereby certifies as follows:
1. The dissolution of
has been duly authorized by the Board of Directors and Stockholders in accordance with
subsections (a) and (b) of Section 275 or by unanimous consent of Stockholders in accordance
with subsection (c) of Section 275 of the General Corporation Law of the State of Delaware.
2. The date of filing of the Corporation’s original Certificate of Incorporation in
Delaware was .
3. The date the dissolution was authorized is
4. The names and addresses of the directors and officers of the corporation are as follows:
NAME TITLE ADDRESS
5. The corporation has no assets and has ceased transacting business.
6. The corporation, for each year since its incorporation in this State, has been required to
pay only the minimum franchise tax then prescribed by Section 503 of the General Corporation
Law of the State of Delaware
7. The corporation has paid all franchise taxes and fees due to or assessable by this State
through the end of the year in which the certificate of dissolution is filed.
By:
Authorized Officer
Name:
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Completed 29 April 2020

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