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FOR OFFICE USE ONLY CORPORATION AND LIMITED LIABILITYCOMPANY
FINALFRANCHISE TAX REPORT
To be submitted prior to Dissolution or Withdrawal
John Thurston
Secretary of State
Business and Commercial Services Division
1401 W. Capitol, Suite 250
Little Rock, Arkansas 72201
(501) 682-3409 or (888) 233-0325
File # www.sos.arkansas.gov
1. 1a.
(Exact Corporate or Limited Liability Company Name as Registered in Arkansas) (Name)
(Street and Number) (Street and Number)
(City State and ZIPCode) (City State and ZIPCode)
1b. Person you wish to have contacted regarding this tax: Name Phone #
Address:
2. Required Information: Please complete with current names (Check One) Foreign Domestic
President 3. State of Incorporation/Organization
Vice-President 4. Date of Incorporation/Organization
Secretary 5. Date of Organization in Arkansas
Treasurer a. Arkansas Registered Agent
Controller b. Nature of Business
Chairman of the Board 6. Federal ID Number
E-mail Address:
Minimum Tax Due
1. Corporation with Authorized Stock $150.00
2. Corporation without Authorized Stock $300.00
3. Limited Liability Company $150.00
I declare, under the penalties of perjury, that the foregoing statements are true to the best of my knowledge
and belief. I understand that the statements made herein are under oath, and that knowingly making a false
statement herein is a Class C felony (A.C.A § 5-53-102) or a Class A misdemeanor (A.C.A. § 5-53-103), or
both.
State of County of
FILED this day of , .
(Remittance Must Accompany This Report)
Rev. 11/18
This form must be signed by: Pres., Vice-Pres., Sec., Treasurer, Controller or Tax Preparer
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