| New York State Library |
NOTE: THIS IS A SAMPLE DOCUMENT ONLY. PLEASE FOLLOW THIS FORMAT AND THE INSTRUCTIONS IN PARENTHESES ( ) WHEN DRAFTING YOUR OWN PETITION. PLEASE BE SURE TO HAVE THE NOTARY PUBLIC INCLUDE A COMPLETE ACKNOWLEDGMENT OF THE SIGNATURES ON THE PETITION, INCLUDING AN ACKNOWLEDGMENT STATEMENT AND HIS/HER STAMP AND SIGNATURE. IF THE SIGNATURES ARE ACKNOWLEDGED SEPARATELY, EACH ACKNOWLEDGMENT MUST INCLUDE THE STATEMENT, STAMP AND SIGNATURE.
|
This document in MS Word format |
TO THE REGENTS OF THE UNIVERSITY OF THE STATE OF NEW YORK:
We, the undersigned, being (EITHER the president and secretary [or any two officers], OR three-fourths of the trustees) of _________________ hereby petition the Board of Regents for an order for the voluntary dissolution of the corporation pursuant to the provisions of Education Law §219 and do hereby make, sign and acknowledge the following statements:
IN WITNESS WHEREOF we have made, signed and acknowledged this application on the _____ day of ___________ 20 __.
_______________________________
Signature
_______________________________
Typed name/title/address of officer
_______________________________
Signature
_______________________________
Typed name/title/address of officer
OR
Signatures of three-fourths of all the trustees listed above. NOTE: in this case, no secretary’s certificate of the board resolution is necessary.
STATE OF NEW YORK )
ss:
COUNTY OF )
On the ________ day of _______________ 20___, before me personally came the ____________ (insert names of officers or trustees who have signed above) trustees listed above, to me known to be the persons described in and who executed the foregoing application, and they severally duly acknowledged to me that they executed the same.
(Typed name, stamp and signature of notary public)