DISSOLVING/TERMINATION CHARITY INFORMATION
Name of Charity
*
Street Address
City
State
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Zip Code
Email
Phone
Phone
Employer Identification Number (EIN)
SUBMISSION INFORMATION
Name of Person Submitting Notice
Street Address
City
State
Select
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Zip Code
Email
Phone
Phone
Receiving Entity(ies) Information
Number of Receiving Entities
*
Select or enter value
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Receiving Entity Name
Address
Email
Phone
Phone
Employer Identification Number (EIN)
Receiving Entity Name
Address
Email
Phone
Employer Identification Number (EIN)
Receiving Entity Name
Address
Email
Phone
Phone
Employer Identification Number (EIN)
Receiving Entity Name
Address
Email
Phone
Phone
Employer Identification Number (EIN)
Receiving Entity Name
Address
Email
Phone
Phone
Employer Identification Number (EIN)
Dissolution Information
Explain why the entity is dissolving or terminating.
State the official purpose of the dissolving or terminating entity. Attach documentation below.
State the official purpose of any receiving entity(ies). Attach documentation below.
List all assets of the dissolving/terminating entity by type (cash, real property, etc.), including values for each and noting any restricted assets and the restrictions on those assets.
List all liabilities of the dissolving or terminating entity and an explanation for how those will be addressed.
Describe the dissolution or termination plan. Attach documentation below.
Explain why the receiving entities were selected.
Has the board of the dissolving or terminating entity voted in favor of the proposed dissolution plan? Attach documentation below.
Yes
No
Have the members, if any, of the dissolving or terminating entity voted in favor of the proposed dissolution plan? Attach documentation below.
Yes
No
Are the receiving entities aware of the dissolution plan and have they agreed to take the assets with any restrictions? Attach any documentation below.
Yes
No
Is there any opposition to the dissolution plan? Any concerns from the community, board or members? Explain. Attach any documentation below.
Yes
No
Attachments
Please label and attach the following documents as applicable:
Dissolving or terminating entity’s articles of incorporation.
Dissolving or terminating entity’s bylaws.
Dissolving or terminating entity’s Board or member meeting minutes and resolutions adopting the dissolution plan.
Dissolution plan.
Dissolving or terminating entity’s last two IRS Form 990s and audited financials or other documentation to show income and expenses over the last two (2) years.
Any gift documents or other documentation relating to restricted assets held by the dissolving or terminating entity.
Documentation to show the status of the dissolving or terminating entity with the Oklahoma Secretary of State (both business and charitable solicitation filings).
Receiving entity(ies)’s articles of incorporation.
Receiving entity(ies)’s bylaws.
Last two (2) IRS Form 990s for receiving entity(ies).
Documentation to show the status of any receiving entity(ies) with the Oklahoma Secretary of State (both business and charitable solicitation filings).
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