Fillable MUSCOGEE (CREEK) NATION CERTIFICATE OF DISSOLUTION

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MUSCOGEE (CREEK) NATION CERTIFICATE OF DISSOLUTION

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MUSCOGEE (CREEK) NATION
CERTIFICATE OF DISSOLUTION
TO: MUSCOGEE (CREEK) NATION SECRETARY OF THE NATION
P.O.
Box 580
Okmulgee, OK 74447
(918) 549-2607
The undersigned, for the purpose of dissolving said corporation pursuant to Section 1096 of the Muscogee
(Creek) Nation General Corporation Act, hereby certifies:
1. The name of the corporation is:
_____________________________________________________________________________________
2. The date of incorporation of such corporation is:________________________________________
3. The name of its registered agent and the street address of its registered office in the Muscogee (Creek)
Nation is:
_____________________________________________________________________________________
Name Street Address City County Zip Code
(P.O. BOXES ARE NOT ACCEPTABLE)
4. The date dissolution was authorized:_________________________________________________
5. Check the applicable statement:
_______ The dissolution has been authorized by the board of directors and shareholders of the
corporation in accordance with subsections A & B of Section 1096.
OR
_______ The dissolution has been authorized by all of the shareholders of the corporation entitled
to vote on a dissolution in accordance with subsection C of Section 1096.
FILING FEE: $50.00
PRINT CLEARLY
6. The names and addresses of its officers are:
NAME ADDRESS CITY STATE ZIP CODE
PRESIDENT _________________________________________________________________
VICE PRESIDENT _________________________________________________________________
SECRETARY _________________________________________________________________
ASST. SECRETARY _________________________________________________________________
TREASURER _________________________________________________________________
7. The names and addresses of its directors, if any, are:
NAME ADDRESS CITY STATE ZIP CODE
DIRECTOR _________________________________________________________________
DIRECTOR _________________________________________________________________
DIRECTOR _________________________________________________________________
IN WITNESS WHEREOF, said corporation has caused this certificate of dissolution to be executed on this
_______ day of _______________, _______.
_______________________________________
Signature
List Title________________________________
_______________________________________
Type or Print Name
ATTEST:
___________________________
Signature
List Title___________________
___________________________
Type or Print Name
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MUSCOGEE (CREEK) NATION CERTIFICATE OF DISSOLUTION

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Completed 1 February 2022

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