Name of Business_________________________________________________________ Any other names under which the entity has done business_________________________ ________________________________________________________________________ Business Address_________________________________________________________ ________________________________________________________________________ Business Telephone number_________________________________________________ Business Fax_____________________________________________________________ Business E-Mail Address___________________________________________________ Person to be Contacted_____________________________________________________ Telephone Number of Contact Person_________________________________________ Business email of contact person_____________________________________________ Employer Identification Number_____________________________________________ Date of Incorporation (or the date that the state gave you permission to conduct business) ________________________________________________________________________ When and where you filed your articles of incorporation, registered your partnership, limited liability articles of organization, etc. ________________________________________________________________________ When and where you filed each certificate of trade name, fictitious name, assumed name ________________________________________________________________________ When and where you obtained a sales tax permit ________________________________________________________________________ When and where you obtained any licenses to conduct your business ________________________________________________________________________ When and where you filed your last tax return ________________________________________________________________________ Full names and addresses of all corporate officers, general partners, members, or any person who is likely to appear on documents that are filed with the state or taxing authorities. Attach list If you have already voted to dissolve: · The date dissolution was approved_________________________________________ · The number of votes cast on the proposal to dissolve__________________________ · The total numbers of votes cast for and against_______________________________ List any dissolution preparations that have already been made, e.g., tax forms filed, plans for liquidation ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ If the law firm will be notifying creditors of your dissolution, list the names and addresses of your creditors Attach list If the law firm will be collecting your assets, list all outstanding assets Attach list The name of your commercial insurance carrier_________________________________ Commercial insurance carrier agent's telephone number___________________________ The name and telephone number of the accountant who will be handling the liquidation or taxes issues ___________________________________________________ |