05-359
       (Rev.2-17/13)                                                                                                     PRINT FORM                                                                CLEAR FIELDS

Request for Certificate of Account Status to  
Terminate a Taxable Entity’s Existence in Texas or Registration
An entity that intends to terminate its legal existence or registration must satisfy filing requirements for all taxes administered by the Comptroller under Title 2 of 
the Texas Tax Code. In addition, all accounts for those taxes must be closed. To determine if the entity is current in tax requirements, or to close any open tax 
accounts, call us at 1-800-252-1381 or 512-463-4600. More information about this process is available online at www.comptroller.texas.gov/taxes/franchise/.
Section A - Entity Information
 Entity’s legal name                                                               Taxpayer number                                        File number (from the Texas Secretary of State)

  1. Is the entity a member of an affiliated group that will be required to file a combined report? ......................................................                                     YES     NO
  If “YES,” enter the following information for the entity that will report on your behalf. If “NO,” skip to Section B.
  Legal name of reporting entity                                                                                     Texas taxpayer number / FEI number

  2. Is the entity’s accounting year begin date on or after the combined group’s accounting year  
  begin date on its franchise tax report? .........................................................................................................................................            YES     NO
  If “YES,” this entity’s information must be included in the combined group report. If “NO,” enter the following information:
  This entity’s                                            month   day    year     The day before the combined                             month                                               day year
  accounting year                                                                  group’s accounting year  
  begin date ............................................                          begin date ............................................
Section B - Texas Entity   - If the entity was formed in Texas, indicate the filing for which the certificate is required.
                                  Termination                                  Merger                                Entity conversion

Section C - Non-Texas Entity   - If the entity was formed outside of Texas, please complete the following information.

  1. Is the entity still conducting business in Texas? ..........................................................................................................................              YES     NO
                                                                                                           month day year
  2. If “NO,” enter the entity’s last day of business in Texas ...........................................

  3. Does the entity currently have an active charter in its home state? ............................................................................................                          YES     NO

  4. If “NO,” indicate the type and date of termination: 
                                                                    month day  year
           Termination effective date .........................
           Merger effective date .................................                                        Name of survivor _______________________________________
           Entity conversion effective date .................
  Note: If the home state charter has been terminated, home state documentation must be included. The home state documentation must bear the seal of 
  the appropriate filing agency and the effective date of the filing.

Section D - Receiving Your Certificate
  Does this entity have a forfeited certificate or registration that needs to be reinstated before ending its existence  
  or registration in Texas? .................................................................................................................................................................. YES     NO
  Please indicate how you would like to receive your certificate:
                     FAX number                                                       Telephone number 
           FAX       (area code and number) ________________________________ (area code and number) ___________________________________
           .PDF      Email address  ______________________________________________________________________________________________
           Mail      Mailing address ______________________________________ City _____________________State  _______ ZIP code __________
  You can file documents online with the Secretary of State using SOSDirect at www.sos.state.tx.us/corp/sosda/index.shtml. 
  Your account will be reviewed to determine eligibility. If eligible, a certificate will be sent using the format selected. If not eligible, we will notify you in  
  writing what is required to be eligible. All requests are processed in the order they are received regardless of the format you select. Assistance is  
  also available at your local field office. Field office locations are available online at www.comptroller.texas.gov/about/contact/locations.php.
 Your name (Please type or print)                                                                                    Phone number and extension

           Authorized agent

                     Visit us online at www.comptroller.texas.gov/taxes/franchise/                                   Mail to:  Comptroller of Public Accounts 
                                  or call 1-800-252-1381 or 512-463-4600.                                            P.O. Box 149348 
                                                                                                                     Austin, TX  78714-9348
Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance with Ch. 552,  
Government Code. To request information for review or to request error correction, contact us at the address or phone number listed on this form.