TM Finance REQUEST FOR CONSENT TO DISSOLUTION NYC DEPARTMENT OF FINANCE G COLLECTION DIVISION Instructions: Please complete, sign and date where indicated and mail to the address above. Under Section 1004 of the Business Corporation Law, As of October 1, 2009, Tax Clearance must be obtained from the NYC Department of Finance (Finance) when dissolving a corporation. The Dissolution Consent must be attached to the Certificate of Dissolution of corporations that have done business in and incurred tax liability to the City of New York. If you are filing a Request for Dissolution on behalf of a corporation, you will need to obtain and submit a signed and dated Power of Attorney with this request. Request for Consent of the Commissioner of Finance for the dissolution of: __________________________________________________ Corporation Name Mail to: NYC Department of Finance, Collection Division, Quality Management/Special Project, 59 Maiden Lane, 28th Fl., New York, NY 10038 _________________________________ Taxpayer Identification Number Address: ______________________________________________________________________________ Number and Street City: __________________________________ State:______ Zip Code: ____________________ Telephone Number: (_______) __________________________ State and County of Incorporation: _____________________________ Date Business Began (in NYC): __________/__________/__________ _________________________________________ Print or Type Name of Signer _________________________________________ Signature Email Address: __________________________________ Date of Incorporation: __________/__________/__________ Date Business Ended (in NYC): __________/__________/__________ _________________________________________ Print or Type Title of Signer ________________________/________________________/________________________ Date Request for Dissolution - Rev. 01.07.2014 American LegalNet, Inc. www.FormsWorkFlow.com