Statement of Intent to Dissolve Revocation of Intent ... - Service Alberta

Statement of Intent to DissolveRevocation of Intent to DissolveBusiness Corporations ActSection 2121.Name of Corporation2.Corporate Access Number3.The Corporation: (check () the appropriate box)(a)Intends to liquidate and dissolve(b)Revokes its intent to dissolveAuthorized Signature(applicable for societies only)Name of Person Authorizing (please print)DateIdentification(not applicable for societies)Title (please print)This information is being collected for the purposes of corporate registry records in accordance with the Business Corporations Act.Questions about the collection of this information can be directed to the Freedom of Information and Protection of Privacy Coordinatorfor the Alberta Government, Box 3140, Edmonton, Alberta T5J 2G7, (780) 427-7013.REG3070 (2003/05)

Statement of Intent to DissolveRevocation of Intent to DissolveBUSINESS CORPORATIONS ACTINSTRUCTIONSThis information is submitted to your authorized service provider for filing with the Registrar pursuant to the BusinessCorporations Act and must conform to Section 1 of the Regulations made under the Act.Item 1. Enter the full legal name of the corporation.Item 2. The corporate access number must be entered. It is printed on the top right hand corner of the:• Certificate of Incorporation• Certificate of Continuance• Certificate of Amalgamation.Item 3. Check either (a) or (b) if the corporation:• intends to liquidate and dissolve under Section 212(3) of the Act.• intends to revoke, under Section 212(10) of the Act, a Certificate of Intent to Dissolve that was previouslyissued under Section 212(5) of the Act.The following information must be included:• signature of person authorizing (applicable for societies only)• name of person authorizing• title• identification (not applicable for societies)• dateWhen the information is submitted to your service provider, identification of the authorized person/officer/director/declarantwill be required, except for societies.FOR SOCIETIES ONLYComplete this form and return both copies(no fee required) to:Service AlbertaPO BOX 1007 STN MAINEDMONTON AB T5J 4W6Walk-in ServiceCorporate RegistryJohn E. Brownlee Bldg.10365 - 97 StreetEdmonton, AlbertaFor information call:Edmonton: (780) 427-2311Toll-free: 310-0000 andthen dial 427-2311REG3070 (2003/05)