Dissolving Nonprofit Questionnaire - Dewlyn Nonprofit Services

ABOUT YOUR ORGANIZATION

Contact Person: *

First

Last

Organization Name: *

Organization Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Website / URL:

Organization Email: *

Organization Phone: *

Employer Identification Number

ORGANIZATION STRUCTURE

How is your organization structured?

Is this organization a foreign entity in another state?

Please list each Board member's name, title, and email address:

Organization Status

Has this organization obtained IRS Public Charity Status?

Has this organization been revoked by the Secretary of State's Office?

Has this organization been revoked by the IRS?

ORGANIZATION ACTIVITIES

Which of the following "purposes" apply to your organization?

Organization's mission statement (under 20 words):

Organization's most significant activities:

List the services that you will provide to the public. A service is something that you “do” – for example: feed the hungry, provide housing or shelter, tutor children, rescue animals, etc.

Does your organization conduct activities outside of the United States?

Please provide a list of all of the organization's current assets (and dollar value).

Additional Information

Please use the space below to share additional information or to ask a pressing question about the dissolution process.

Thank you for completing this questionnaire. Your responses will guide our understanding of your organization and areas where we can offer you support. Unless otherwise promised, please allow 1-2 business days for us to properly review your responses and contact you with next steps.

I certify that the information provided is true based on my understanding.

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