166918 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 362260 Page 1 of 1
ONE CIVIC SQUARE TODD ROKITA, SECRETARY OF STATE
CARMEL, INDIANA 46032 CORPORATIONS DIVISION CHECK AMOUNT: $30.00
.oN `o 302 N WASHINGTON ST., RM E106 CHECK NUMBER: 166918
INDIANAPOLIS IN 46204
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBE INVOICE NUMBER AMOUNT DESCRIPTION
852 5023990 30.00 OTHER EXPENSES
1
I'. ARTICLES OF DISSOLUTION OF A TODD ROKITA
DOMESTIC NONPROFIT CORPORATION SECRETARY OF STATE
State Form 39060 (R6/12-02) St., R
Corporate Form No. 364 -5 (1-88) CORPORATIONS N
302 W. Washington St., Rm. E018
Approved by State Board of Accounts 1995 Indianapolis, IN 46204
Telephone: (317) 232 -6576
INSTRUCTIONS: Use 8 V2 "x 11" white paper for attachments.
Present original and one copy to address in upper right comer of this form. Indiana Cade 23-17 -22-3
Please TYPE or PRINT. FILING FEE IS $30.00
Please visit our ofte on the web at www.sos.ingnv
ARTICLES OF DISSOLUTION
OF A
DOMESTIC NONPROFIT CORPORATION
The undersigned officer of the Indiana Nonprofit Corporation named in Article I below (hereinafter referred to as the "Corporation) desiring to give
notice of corporate action effectuating the dissolution of the Corporation pursuant to the provisions of the Indiana Nonprofit Corporation Act of 1991
(hereinafter referred to as the Act"), certifies the following facts:
•--e•
Name of Corporation
i
Date of lnoorporation
ARTICLE Ill. UTH ORIZATIO N
Dissolution was authorized (pursuant to Indiana Code 23- 17 -22 -2) on eC,� r .20
Dissolution was approved by a sufficient vote of the Board of Directors.
Yes No
s
IF APPROVAL OF MEMBERS WAS NOT REQUIRED:
Dissolution was approved by a sufficient vote of the Board of Directors or Incor tors.
es No
Dissolution was approved by a person other than the members, and that approval pursuant to Indiana Code 23- 17 -22 -2 (b) (3) was obtained.
Yes No
IF APPROVAL OF MEMBERS WAS REQUIRED, A OR B MUST BE COMPLETED:
MEMBERS OR DELEGATES
A. VOTES CAST FOR OR AGAINST DISSOLUTION TOTAL ENTITLED TO VOTE AS A CLASS
1 2 3
MEMBERS OR DELEGATES ENTITLED TO VOTE
MEMBERS OR DELEGATES VOTED IN FAVOR
MEMBERS OR DELEGATES VOTED AGAINST 0
MEMBERS OR DELEGATES
B, FOR USE WHERE VOTES ARE UNDISPUTED TOTAL ENTITLED TO VOTE AS A CLASS
1 2 3
MEMBERS OR DELEGATES ENTITLED TO VOTE
TOTAL NUMBER OF UNDISPUTED VOTES
IN WITNESS WHEREOF, the undersi being the L� Q�1 V of the Corporation executes these Articles of Dissolution and
Nr
verifies, under penalties of per' t the statements herein are true, this day of 20 C
Signature Printed name
NOTE: Notice of Voluntary Dissolution must be filed with the following State agencies: the Unclaimed Property Section of the Attorney General
of Indiana (IC 32- 9- 1 -14); the Department of Revenue (IC 6- 8.1- 10 -8); and the Indiana Department of Workforce Development (IC 22-4-
32-22). Clearances from these agencies are no longer necessary.
Indiana Department of Revenue Indiana Department of Workforce Development Indiana Attorney General
Compliance Division Employer Audit Section Unclaimed Property Section
100 N. Senate Ave., Room N203 10 N. Senate Ave. 402 W. Washington St., 5th Floor
Indianapolis IN 46204 Indianapolis IN 46204 Indianapolis, IN 46204
Telephone: (317) 232 -2118 Telephone: (317) 232 -7436 Telephone: (317) 232 -6348
Pres °bed by State Board of Accounts City Form No. 201 (Rev. 1995)
e ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
f Payee
Todd Rokits, Secretary of State Purchase Order No.
•Corporate Division
302 W. Washington St., RM E018 Terms
Indianapolis, IN 46204
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12'/,3/08 payment for dissolution of SWAT Association 30.00
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
.-1%
VOUCHER NO. WARRANT NO.
ALLOWED 20
T odd Rokita. Secretary of State
Cor� rations Division IN SUM OF
302 W.. Washington Street, RM E018
Indianapolis. IN 46204
30.00
ON ACCOUNT OF APPROPRIATION FOR
p olice gift fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
852 30.00 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
December 3 20 08
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund