IT-966 SF# 50150 (R2 / 2-08) NOTICE OF CORPORATE DISSOLUTION LIQUIDATION OR WITHDRAWAL (Required under IC 6-8.1-10-9) Name of Corporation: Employer Identification Number: Address: Indiana Taxpayer Identification Number: City or Town, State and ZIP Code: Type of Indiana Corporate Return filed: Date Incorporated: Market value of Corporate Assets: State of Incorporation: Corporate Liabilities: Type of Liquidation: Partial Last month, day & year of final tax year: Complete Date of Dissolution: Was corporation’s final return filed as part of a consolidated income tax return? Yes No Employer Identification Number: Name of common parent: Date of any amendments to plan of dissolution: Section of the Internal Revenue Code under which the corporation is to be dissolved or liquidated: Under the penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. _______________________________________________ Signature of Officer ____________________________________ Title __________ Date Name/Address/Social Security Number of Corporate Officers/Directors/Shareholders. (Use additional sheets if Necessary.) Name of Corporate Official/Shareholder Address of Corporate Official/Shareholder Social Security Number The following information must be attached to this form: (1) A copy of the minutes of the shareholders’ meeting at which the plan or resolution was formally adopted. (2) A copy of the corporation’s certificate of dissolution or a copy of the corporation’s certificate of withdrawal. (3) A complete explanation of the plan or resolution. (4) A copy of the Final Corporate Returns, both Federal and State. American LegalNet, Inc. www.FormsWorkflow.com Additional Information concerning Form IT-966 This form is required for all corporations and or organizations dissolving or liquidating in Indiana. A Power of Attorney (POA-1) is needed if someone other than a corporate officer requests a clearance for a corporation or organization effecting dissolution, liquidation, or withdrawal. A corporation may formally request the department issue a clearance to a corporation effecting dissolution, liquidation, or withdrawal if: 1. All necessary tax returns(including the final tax return) have been filed in a timely manner. 2. All tax payments and liabilities due or determined due to the department have been paid. 3. The form of notification (Form IT-966) was filed with the department within thirty (30) days of the issuance of a certificate of dissolution, decree of dissolution, the adoption of a resolution or plan, or the filing of a statement of withdrawal. The request for clearance must be made in writing by the officers and directors of the corporation within thirty (30) days after the filing of the form of notification with the department. The issuance of a clearance under IC 6-8.1-10-9(g) releases the officers and directors from personal liability under IC 6-8.1-10-9. If the corporation does not request the department issue a clearance to a corporation effecting dissolution, liquidation or withdrawal, the department has one (1) year from the date of this form or the filing of all necessary tax returns, including the final tax returns, whichever is later, to assess any tax or liabilities that may be due the department. The corporate officers, directors remain personally liable for any acts or omissions that result in the distribution of corporate assets before all state or county tax liabilities have been satisfied. An officer or director held liable for an unlawful distribution under IC 6-8.1-10-9 is entitled to contribution from every other director who voted for or assented to the distribution and from each shareholder for the amount of distribution accepted by the shareholder. A not-for-profit organization that is dissolving, liquidation or withdrawing from Indiana must file Form IT-966. If the not-for-profit organization requests clearance be issued, the not for profit organization must be duly registered with the department and have filed all necessary Forms NFP-20 and IT-20NP, if applicable. For any questions regarding this form, you may call (317) 233-0389. Mail the form to: Indiana Department of Revenue Enforcement Division / Corporate Dissolutions 100 North Senate Ave., Room N241 Indianapolis, IN 46204-2253 American LegalNet, Inc. www.FormsWorkflow.com