Item 1 - Entity Name
Item 2 - Entity Type
Item 3 - Date of Formation
Item 4 - File Number
Item 5 - Governing Persons
Set forth the name and address of each governing person of the entity.
NAME (Enter the name of either an individual or an organization, but not both).
IF INDIVIDUAL
OR
IF ORGANIZATION
ADDRESS
Item 6 - Event Requiring Winding Up
Select the nature of the event requiring winding up or termination of the entity:
Statement Regarding Completion of Winding Up
Governing Person Approval
If the winding up event is a voluntary decision, indicate how the decision was approved:
Effectiveness of Filing (Select either A, B, or C.)
Execution
The undersigned signs this document subject to the penalties imposed by law for the submission of a materially false or fraudulent instrument and certifies under penalty of perjury that the undersigned is authorized under the Texas Business Organizations Code to execute the filing instrument on behalf of the entity.
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