Organization Dissolution Proxy Vote Form

Organization Dissolution Proxy Vote Form
Submit your official proxy vote for the dissolution of your organization. All fields are required for accurate processing.
Organization name
Organization type
Member/shareholder name
First NameLast Name
Email address
example@example.com
Mailing address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Proxy giver or voter status/relationship to the organization
Dissolution meeting or vote date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Proxy vote choice for the dissolution decision
Proxy holder / authorized representative name
First NameLast Name
Additional instructions or special voting instructions
Should be Empty: