Dissolution Of Corporation Form.pdf

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1. Name of Corporation Sole:
2. The reason for the filing of the certificate of dissolution:
3. Any other information the representative filing the certificate determines:
4. Signature:
Name of Subscriber or Successor
Signature
FILING FEE: $50.00
ABOVE SPACE IS FOR OFFICE USE ONLY
USE BLACK INK ONLY - DO NOT HIGHLIGHT
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Dissolution of
Corporation Sole
(PURSUANT TO NRS CHAPTER 84)
This form must be accompanied by appropriate fees.
IMPORTANT:  Failure to include any of the above information and submit with the proper fees may cause this filing to be rejected.
Nevada Secretary of State NRS 84 Dissolution
Revised:  3-13-09
Certificate of Dissolution
For a Nevada Corporation Sole
 (Pursuant to NRS Chapter 84)
ROSS MILLER
Secretary of State
204 North Carson Street, Suite 1
Carson City, Nevada 89701-4520
(775) 684 5708
Website:  www.nvsos.gov
Nevada Secretary of State AM Instructions  
Revised on: 3-5-09 
 
ROSS MILLER 
Secretary of State 
204 North Carson Street, Suite 1 
Carson City, Nevada 89701-4520 
(775) 684 5708 
Website: www.nvsos.gov 
 
 
     IMPORTANT:  READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORM.  
     
    Dear Customer:  We value your patronage and desire to provide you the best service 
    possible.  In an effort to facilitate your filing we would appreciate your taking a moment  
    to read the following before submitting your document.  Failure to include any of the 
    information required on the form may cause the filing to be rejected. 
-Thank you- 
 
1.)  One file stamped copy of the filing will be returned at no additional charge.  To receive a certified copy, 
enclose an additional $30.00 per certification.  A copy fee of $2.00 per page is required for each additional copy 
generated when ordering 2 or more file stamped or certified copies.  Appropriate instructions must accompany 
your order.   
 
2.)  If paying for expedite service, include the word “EXPEDITE” in your correspondence. 
 
 
3.)  Verify filing is submitted on the correct form prescribed by the Secretary of State. 
 
4.)  Forms must include appropriate signatures as required. 
 
5.)  If applicable, include the appropriate names and addresses as requested on the form. 
 
6.)  If adding new managers or general partners, their names and addresses must be set forth. 
 
7.)  Documents must reflect the complete name of the entity as registered with the Secretary of State. 
 
8.)  Attach all pages that are referenced as attachments. 
 
               9.)  All documents must be legible for filming and/or scanning. 
 
10.)  If filing restated articles (containing newly amended articles, deletions or additions), provide a form 
prescribed by the Secretary of State indicating which articles have been amended, deleted or added.  
Furthermore, the articles must contain the necessary amendment language as required by the statutes governing 
amendments for that type of business entity. 
 
11.)  Verify that the status of the entity is not revoked.  Verification may be made by visiting our Web site at 
www.nvsos.gov or calling this office. 
 
               12.)  The correct filing date must be provided when required. 
 
               13.)  All required information must be completed and appropriate boxes checked or filing will be rejected. 
 
               14.)  Please contact this office for assistance if you are unsure of the filing fee for your document. 
 
All forms may be downloaded from our Web site www.nvsos.gov.  The Nevada Revised Statutes may be obtained 
at http://www.leg.state.nv.us/NRS.  
 
      Filing may be submitted at the office of the Secretary of State or by mail at the following addresses: 
 
 
 
 
 
 
 
 
 
 
 
 
 
Filing Instructions for the 
Amendments Division 
MAIN OFFICE:   
Regular and Expedited Filings  
SATELLITE OFFICES: 
Expedited Filings Only 
Secretary of State 
Amendments Division 
204 North Carson Street, Suite 1 
Carson City NV  89701-4520 
Phone: 775-684-5708 
Fax: 775-684-5731 
Secretary of State – Las Vegas 
Commercial Recordings Division 
555 East Washington Ave, Suite 5200 
Las Vegas NV  89101 
Phone: 702-486-2880 
Fax: 702-486-2888 
Secretary of State - Reno 
Commercial Recordings Division 
1755 East Plumb Lane, Suite 231 
Reno NV  89502 
Phone: 775-688-1257 
Fax: 775-688-1858 
24-Hour Expedite
Date:
Phone:
Hold for Pick Up
Method of Payment:
Check/Money Order
Total Amount:
Name of Entity:
SUBMIT THIS COMPLETED FORM  WITH YOUR FILING
USE BLACK INK ONLY - DO NOT HIGHLIGHT
Regular
(additional fee included)
Contact Name:
Trust Account:
Use balance remaining in job #
Mail to Address Above
Return to:
eCheck/Credit Card (attach checklist)
ROSS MILLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684 5708
Website:  www.nvsos.gov
Nevada Secretary of State Customer Order Instructions
Revised:  9-26-08
*PLEASE NOTE:  this office keeps the original paperwork.  The first file
stamped copy ordered at the time of filing is at no charge.  Each additional
copy is $2.00 per page (plus $30.00 for each certification).
Order Description: (include items being ordered and fee breakdown)*
Return Delivery:  (email or fax options do not receive a copy via mail; must be ordered separately)
Processing
Service Requested:
Fax to:
Email to:
Other: (explain below)
FedEx: Acct #
Customer Order Instructions
Date:
Phone:
Hold for Pick Up
Method of Payment:
Check/Money Order
Total Amount:
Name of Entity:
SUBMIT THIS COMPLETED FORM  WITH YOUR FILING
USE BLACK INK ONLY - DO NOT HIGHLIGHT
Contact Name:
Trust Account:
Use balance remaining in job #
Mail to Address Above
Return to:
eCheck/Credit Card (attach checklist)
ROSS MILLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684 5708
Website:  www.nvsos.gov
Nevada Secretary of State 1-2 Hr Customer Order Instructions
Revised:  9-25-08
*PLEASE NOTE:  this office keeps the original paperwork.  The first file
stamped copy ordered at the time of filing is at no charge.  Each additional
copy is $2.00 per page (plus $30.00 for each certification).
Order Description: (include items being ordered and fee breakdown)*
Return Delivery:
Processing
Service Requested:
Fax to:
Email to:
Other: (explain below)
FedEx: Acct #
1 or 2-Hour Expedite
Customer Order Instructions
2-Hour Expedite
(additional $500.00 fee included)
1-Hour Expedite
(additional $1000.00 fee included)
 
 
 
 
  
24-hour, 2-hour and 1-hour 
Expedite Service Guidelines  
ROSS MILLER 
Secretary of State 
202 North Carson Street 
Carson City, Nevada 89701-4201 
Phone: (775) 684 5708 
Website: www.nvsos.gov 
 
IMPORTANT:  To ensure expedited service, please mark “Expedite” in a conspicuous place at 
the top of the service request.  Please indicate method of delivery. 
 
24-HOUR EXPEDITE SERVICE 
 
The Secretary of State offers a 24-hour expedite service on most filings processed by this office.  If you choose to utilize 
this service, please enclose with your filing the additional expedite fee.  Please note that this expedite fee is in addition to 
the standard fee charged on each filing and/or order.  Check the 24-hour expedite box on your customer order instruction 
form.  If not using our order form, state clearly in your cover letter that you are requesting 24-hour expedited service, 
include your telephone number and return information.  Attach the order form or cover sheet to the top of your filing and 
submit to this office.  Each filing will be returned by U.S.P.S. regular mail unless other arrangements are made.  This 
office does not fax confirmation of a 24-hour expedite. 
 
The fee for 24-hour handling ranges from $25.00 to $125.00.  Please consult our fee schedules for the appropriate 24-
hour expedite fee.  If you require assistance, please contact this office. 
 
Time Constraints:  Each filing submitted receives same day filing date and may be picked up within 24-hours.  Filings to 
be mailed the next business day if received by 2:00 pm of receipt date and no later than the 2nd business day if received 
after 2:00 pm.  Expedite period begins when filing or service request is received in this office in fileable form.   
 
2-HOUR EXPEDITE SERVICE 
 
The Secretary of State offers a 2-hour expedite service on most filings processed by this office.  If you choose to utilize 
the 2-hour expedite service, please enclose with your filing an additional $500.00 per filing and/or order.  Please note that 
this expedite fee is in addition to the standard fee charged on each filing and/or order.  Complete and submit the 2-hour 
customer order instruction form.  If not using our order form, state clearly in your cover letter that you are requesting 2-
hour expedited service and include your telephone number and return information.  Attach the order form or cover sheet 
to the top of your filing and submit to this office.  Each filing will be returned by U.S.P.S. regular mail unless other 
arrangements are made. 
 
1-HOUR EXPEDITE SERVICE 
 
The Secretary of State offers a 1-hour expedite service on most filings processed by this office.  If you choose to utilize 
the 1-hour expedite service, please enclose with your filing an additional $1000.00 per filing and/or order.  Please note 
that this expedite fee is in addition to the standard fee charged on each filing and/or order.  Complete and submit the 1-
hour customer order instruction form.  If not using our order form, state clearly in your cover letter that you are requesting 
1-hour expedited service and include your telephone number and return information.  Attach the order form or cover sheet 
to the top of your filing and submit to this office.  Each filing will be returned by U.S.P.S. regular mail unless other 
arrangements are made. 
 
1-Hour and 2-Hour Time Constraints:  Each filing submitted for either 1-hour or 2-hour expedite receives same day 
filing date and will be acknowledged by fax or e-mail within expedite service time.  Failure to indicate method of 
acknowledgement (fax or e-mail) or to provide a correct fax number or e-mail address may prevent the Secretary of State 
from acknowledging the filing of such documents.  Filings may be picked up within the expedite service period. Filings to 
be mailed will be mailed out no later than the next business day following receipt.  Expedite period begins when filing or 
service request is received in this office in fileable form. 
 
 
The Secretary of State reserves the right to extend the expedite period in times of extreme 
volume, staff shortages or equipment malfunction.  These extensions are few and will rarely 
extend more than a few hours. 
Nevada Secretary of State Expedite Guidelines  
Revised: 7-1-08 
Fax
Mail
Counter
Service Type:
Billing Address
City, State, Zip
Telephone
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ePayment Checklist
(For Counter, Fax and Mail Requests)
Name as it Appears on the Account
Account Number:
Routing Number:
Amount of Electronic Check:
Payment Authorization
Nevada Secretary of State ePayment Checklist
Revised: 2-9-09
I authorize the Secretary of State to bill an amount not to exceed the following to be charged to the above listed
account(s):
Not to Exceed Amount:
Authorized Signature
Entity Name/Order Reference:
Account/Card Holder Information:
USD $
USD $
Order Processing Requested:
24-HOUR Expedite
2-HOUR Expedite
1-HOUR Expedite
Regular Processing
(Expedite Processing Requires Additional Fees)
Account Type;
Checking
Savings
Order Information (required)
Payment by Electronic Check  (account holder name and address required below)
 MasterCard
VISA
Customer Credit Card Number:
V CODE*
Year
Month
 Discover
 American Express
* 3-digit number found on the far right of the backside of VISA, MasterCard and Discover cards
4-digit number found on the front right side of American Express card.
Card Type:
NOTICE:  For security and verification purposes, all credit card payments must include the 3 or 4-digit CVV2 code
(VCode) number located on the credit card.  Failure to include this code will result in the rejection of your filing or service
request.
Credit Card Expiration Date:
Amount to Charge Card:
Payment by Card  (card holder name and billing address required below)
USD $
ROSS MILLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684 5708
Website:  www.nvsos.gov
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