Kansas Non Profit Corporation Dissolution by Meeting Form

In Kansas, the cancellation of a nonprofit corporation through the meeting of members/stockholders require the use of this form. Completed copy of the form plus the check for the $__.00 filing fee must be sent to the following address: __________________.Download

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Above space is for office use only.	
    _______________________________________	
CONTACT:	  Kansas Office of the Secretary of State	
Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594	 	
(785) 296-4564
[email protected]
www.sos.ks.gov	
NM
53-13	
KANSAS SECRETARY OF STATE
Not-For-Profit Corporation 
Dissolution by Members’ Meeting	
INSTRUCTIONS:  	All information must be completed or this document will not be accepted for filing. 	 	
Please read instructions before completing.	i	
Page 1 of 2	
1.  Business entity ID number:This is not the Federal Employer ID Number (FEIN)
2.  Name of corporation:Name must match the name on record with the Secretary of State	
K.S.A	. 17-6804, 	K.S.A. 17-6805	Rev. 12/27/10 jdr	
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___________________	_	
   _	__________________________________________________________________________\
________	__	_  	 Name                                                 
________________________________________________________________________\
_____________	__ 	 Mailing address                               City                                       State               Zip              	Cou	n t r y       	
   _____________________________________________________________________\
_______________	__  	 Name                                                 
________________________________________________________________________\
_________________	_ 	 Mailing address                               City                           State              Zip               Country      
   _____________________________________________________________________\
_____________	___  	 Name                                                 
_____________________________________________________________________	__ _ _ _ _ ________________	________ _	 	 Mailing address                                City                                       State                 	  Zip               Country      	
1)
2)
3)	
3.  Name and mailing address of each officer: Do not leave blank
If additional space is needed please provide an attachment	
   _	__________________________________________________________________________\
________	__	_  	 Name                                                 
________________________________________________________________________\
_____________	__ 	 Mailing address                               City                                       State               Zip              	Cou	n t r y       	
   _____________________________________________________________________\
_______________	__  	 Name                                                 
________________________________________________________________________\
_________________	_ 	 Mailing address                               City                           State              Zip               Country      
   _____________________________________________________________________\
_____________	___  	 Name                                                 
_____________________________________________________________________	__ _ _ _ _ ________________	________ _	 	 Mailing address                                City                                       State                 	  Zip               Country      	
1)
2)
3)	
4.  Name and mailing address of the board of directors: Do not leave blank
If additional space is needed please provide an attachment

Page 2 of 2	Rev. 12/27/10 jdr	K.S.A	. 17-6804, 	K.S.A. 17-6805	
Instructions:	  	
1.  If this form is submitted after the close of the entity’s tax year, an annual report and fee must be filed along with or  
 prior to dissolution.  If the entity has forfeited, it must reinstate before dissolution.  
2.  Submit this form with the 	$20	 filing fee.   	
STAY UP-TO-DATE ON YOUR ORGANIZATION’S STATUS, ANNUAL REPORT DUE DATE AND CONTACT ADDRESSES BY GOING TO WWW.SOS.KS.GOV.  UNDER QUICK LINKS, SELECT SEARCH BUSINESS ENTITY INFORMATION. 
NOTICE: 	There is a $25 service fee for all checks returned by your financial institution.	 	All information must be completed or this document will not be accepted for filing.  
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5.  Effective date:A future effective date must be within 90 days of filing date	
Upon filing
Future effective date	_____________________________	_ 	   Month               Day                     Year          	
6.  Dissolution of the corporation is authorized in accordance with K.S.A. 17-6804.
7.  I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct and 
that I have remitted the required fee.   	  	
________________________________________________________    ____________\
__________________________________________	__     	      Signature of authorized officer                   Date (month, day, year)
________________________________________________________    	      	      Name of signer (printed or typed)                                        
                   	
Save time by filing your dissolution online at www.sos.ks.gov