Entity Number: ________________________
Pursuant to the provisions of the Uniform Limited Cooperative Association Act, the undersigned directors or
incorporators adopt the following Articles of Dissolution.
1): Limited Cooperative Association Name: _____________________________________________________
2): The date the LCA dissolved or will dissolve: ______________________
3): The address of the LCA’s principal office or other address where service of process may be mailed:
_________________________________________________________________________________________
Street Address City State Zip
(Utah Street Address Required, PO Boxes can be listed after the street address)
Under penalties of perjury I declare that these Articles of Dissolution have been examined by me and are,
to the best of my knowledge and belief, true, correct and complete.
By: ________________________________________ Title: ______________________ Date: _____________
If the filer requests a copy of the Application of Dissolution an additional exact copy of the filed document
along with a return-addressed envelope with adequate first-class postage must also be submitted.
Under GRAMA {63G-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
State of Utah
DEPARTMENT OF COMMERCE
Division of Corporations & Commercial Code
Application of Dissolution
Limited Cooperative Association
This form cannot be hand written.
Authorized party must sign here after the form is printed
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
www.corporations.utah.gov
