05-359
(Rev.2-24/14) PRINT FORM CLEAR FIELDS
Request for Certificate of Account Status to
Terminate a Taxable Entity’s Existence in Texas
An entity that intends to terminate its legal existence or registration must satisfy filing requirements for all taxes administered by the Comptroller under Title 2 of
the Texas Tax Code. More information about this process is available online at www.comptroller.texas.gov/taxes/franchise/certificate-letter-request.php.
Section A - Entity Information
Entity’s legal name Taxpayer number File number (from the Texas Secretary of State)
Check all that apply.
Section B - Texas Entity - If the entity was formed in Texas, indicate the filing for which the certificate is required.
Termination Merger Entity conversion
Section C - Non-Texas Entity - If the entity was formed outside of Texas, please complete the following information.
1. Enter the entity’s last day of business in Texas _______________
2. Does the entity currently have an active charter in its home state? ............................................................................................................ Yes No
3. If “NO,” indicate the type and date of termination:
month day year month day year
Termination effective date ................... Entity conversion effective date
Merger effective date........................... Name of survivor _____________________________________
Note: If the home state charter has been terminated, home state documentation must be included. The home state documentation must bear the seal of
the appropriate filing agency and the effective date of the filing.
Section D - Receiving Your Certificate
Does this entity have a forfeited certificate or registration that needs to be reinstated? ................................................................................. Yes No
Please indicate how you would like to receive your certificate:
FAX number Telephone number
FAX (area code and number) ______________________________ (area code and number) ___________________________________
.PDF Email address ______________________________________________________________________________________________
Mail Mailing address ______________________________________ City _____________________ State _______ ZIP code __________
You can file documents online with the Secretary of State using SOSDirect at www.sos.state.tx.us/corp/sosda/index.shtml.
If not eligible, we will notify you in writing what is required to be eligible. We process requests in the order we receive them regardless of the format you
select. Assistance is available at your local field office. Field office locations are available online at www.comptroller.texas.gov/about/contact/locations.php.
Your name (Please type or print) Phone number and extension
Authorized agent
Mail to: Comptroller of Public Accounts
Visit us online at www.comptroller.texas.gov/taxes/franchise.
P.O. Box 149348
Visit www.comptroller.texas.gov/about/contact for locations and phone numbers.
Austin, TX 78714-9348
Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance with Ch. 552,
Government Code. To request information for review or to request error correction, contact us at the address listed on this form.
