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                                                Charitable Activities Section                                     DOJ 
                                                                                                                  Registration #: 
                                            Oregon Department of Justice 
      Closing                            
                                        100 SW Market Street                                VOICE (971) 673-1880 
                                        Portland, OR 97201-5702                               TTY (800) 735-2900 
                                        E-Mail: charitable@doj.state.or.us                  FAX   (971) 673-1882 
         Form                           Web site: http://www.doj.state.or.us 
  
 Who Must File 
    This form is to be completed by Oregon public benefit and religious corporations.  If your organization is a foreign corporation or a 
    trust, please contact the Department of Justice for special instructions on closing procedures. 
  
 Notice to the Attorney General 
    Oregon Revised Statute 65.627 requires a public benefit or religious corporation to provide written notice to the Attorney General of 
    their intent to dissolve at or before the time it delivers articles of dissolution to the Secretary of State.  The notice shall include a copy 
    or summary of the plan of dissolution.  No assets shall be transferred or conveyed as part of the dissolution process until 30 
    days after the required written notice has been given to the Attorney General or until the Attorney General has consented in 
    writing, or indicated in writing, that the Attorney General will take no action in respect to the transfer or conveyance, whichever is 
    earlier.  When all or substantially all of the assets have been transferred or conveyed following approval of dissolution, the board shall 
    deliver to the Attorney General a list showing those, other than creditors, to whom the assets were transferred or conveyed. 
  
 Purpose of Form 
    This form is used to report to whom you intend to transfer or convey assets as part of your plan of dissolution, and/or to whom you 
    have already transferred or conveyed assets as part of your dissolution. 
     
   1.  Name 
    Write the corporation’s legal name. 
     
                __________________________________________________________________________________________________________                   
     
   2.  Articles of Dissolution                                                                                                               
    Have you filed Articles of Dissolution with the Secretary of State? 
                   Yes  If yes, when were they filed?:__________________________________________________________________________ 
                 
                   No   If no, please explain:_________________________________________________________________________________ 
      
   3.  Disposition of Assets 
    List recipients and/or intended recipients of the corporation’s assets at dissolution (other than creditors).  If necessary, 
    attach additional pages. 
         Recipient (Please indicate the full legal name of recipient)  Distributed yet?           Type of Asset   Value of Asset            
       Name:                                                                                                                                
                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
                                                                               Yes 
       Address:  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                 
                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                         No 
                  
       Name:                                                                                                                                
                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
                                                                               Yes 
       Address:  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                 
                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                         No 
                  
       Name:                                                                                                                                
                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
                                                                               Yes 
       Address:  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                 
                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                         No 
                  
  Please     Under penalties of perjury, I declare that I have examined this form, including any attachments, and to the best of my 
             knowledge and belief, it is true, correct, and complete. 
  Sign 
  Here       ⇒ 
                  _______________________________________________         ________________________________________________ 
                  Signature                                                   Address 
              
                  _______________________________________________         ________________________________________________ 
                  Printed name                                                City/State/Zip 
              
                  _______________________________________________         ________________________________________________ 
                  Title or Relationship to corporation                        Phone 
              
                  _______________________________________________      
                  Date