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Please submit payment by check, money order, or credit card 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your Business Entity ID number in the designated field. Ensure this is not your Federal Employer ID Number (FEIN).
  3. Next, input the name of your corporation. This must match the name on record with the Secretary of State.
  4. Provide the names and mailing addresses of each officer associated with your corporation. If more space is needed, attach an additional document.
  5. Fill in the names and mailing addresses of the board of directors similarly, ensuring no fields are left blank.
  6. Select an effective date for dissolution. This can be immediate or a future date within 90 days from filing.
  7. Finally, sign and print your name as the authorized officer, along with your phone number. Review all entries for accuracy before submission.

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