Telephone: 877.767.3453   
                                   OhioSoS.gov  |  business@OhioSoS.gov 
                                   File online or for more information: OhioBusinessCentral.gov

                                   Filing Form Cover Letter

Please return the approval certificate to:

Name (Individual or Business Name):

To the Attention of (if necessary):

Address:

City:

State                                                                    ZIP Code:

Phone Number:                             E-mail Address:

         Check here if you would like to receive important notices via email from the Ohio Secretary of State's office regarding 
         Business Services.

         Check here if you would like to be signed up for our Filing Notification System for the business entity being created or 
         updated by filing this form. This is a free service provided to notify you via email when any document is filed on your 
         business record.

Please make checks or money orders payable to: "Ohio Secretary of State" 
Type of Service Being Requested:  (PLEASE CHECK ONE BOX BELOW)

Regular Service: Only the filing fee listed on page one of the form is required and the filing will be 
processed in approximately 3-7 business days.  The processing time may vary based on the volume of 
filings received by our office.

Expedite Service 1:  By including an Expedite fee of $100.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 2 business days after it is received by our office. 

Expedite Service 2:  By including an Expedite fee of $200.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 1 business day after it is received by our office. This 
service is only available to walk-in customers who hand deliver the document to the Client Service Center.

Expedite Service 3:  By including an Expedite fee of $300.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00 
p.m.  This service is only available to walk-in customers who hand deliver the document to the Client Service Center.

Preclearance Filing:  A filing form, to be submitted at a later date for processing, may be submitted to be 
examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The 
Preclearance will be complete within 1-2 business days.

Form 560                                  Page 1 of 6                             Last Revised: 02/2023

Form 560 Prescribed by:
                                                                                                  Mail this form to one of the following: 
                                     Telephone: 877.767.3453                                      Regular Filing (non expedite) 
                                                                                                  P.O. Box 1329 
                                     OhioSoS.gov                                                  Columbus, OH  43216 
                                     business@OhioSoS.gov                                         Expedite Filing (Two business day processing time. 
                                                                                                                            Requires an additional $100.00) 
                                     File online or for more information: OhioBusinessCentral.gov P.O. Box 1390 
                                                                                                  Columbus, OH  43216

For screen readers, follow instructions located at this path.

                                     Certificate of Dissolution 
                                     (Nonprofit, Domestic Corporation) 
                                                             Filing Fee: $50 
                       (139-DISM (Members) & 175-DIST (Directors)) 
                                                             Form Must Be Typed 

Complete the following information.

The corporation named below has adopted a resolution of dissolution. 
 
 Name of Corporation

 Charter Number

Location of Principal Office in Ohio 
 
                                                                                                                                OH
 City                                                                           County                                          State

Names and addresses of the directors.

 Name                                                         Address

 Name                                                         Address

 Name                                                         Address

Form 560                                                     Page 2 of 6                                                    Last Revised: 02/2023

Names and addresses of the officers. 

Name                                                       Address

Name                                                       Address

Name                                                       Address

Name and address of the Statutory Agent. 

Name of Statutory Agent

Mailing Address

                                                                           OH
City                                                                       State         ZIP Code

Please complete this section if the corporation is appointing a new agent. 

                           ACCEPTANCE OF APPOINTMENT 

The Undersigned,                                                                   , named herein as the
                    Statutory Agent Name

Statutory agent for,
                    Corporation Name

hereby acknowledges and accepts the appointment of statutory agent for said corporation. 

Statutory Agent Signature
                         Individual Agent's Signature/Signature on behalf of Business Serving as Agent

The date of dissolution if other than the filing date 
                                                      dissolution date (MM/DD/YYYY)

Note: The date of dissolution must be on the date of filing, or a later date that is not more than 90 days after the date 
of filing, pursuant to Ohio Revised Code section 1702.47(H)

Form 560                                 Page 3 of 6                                     Last Revised: 02/2023

Check the appropriate box and provide information as required:

 The resolution of dissolution was adopted by the Directors. Pursuant to Ohio Revised Code section 
 1702.47(C), directors may adopt a resolution in the following cases, please check the box to state the proper 
 statement of the basis for the adoption.

         When the corporation has been adjudged bankrupt or has made a general assignment for the benefit of 
         the creditors;
         By leave of the court, when a receiver has been appointed in a general creditor's suit or in any suit in 
         which the affairs of the corporation are to be wound up;
         When substantially all of the assets have been sold at judicial sale or otherwise; or
         When the period of existence of the corporation specified in its articles has expired.

 The resolution of dissolution was adopted by the Members pursuant to Ohio Revised Code section 
 1702.47(D).

By signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she 
has the requisite authority to execute this document.
Required     
 
Must be signed by an authorized      Signature
officer, unless the officer fails to 
execute and file the certificate 
within30 days after the adoption 
                                     By (if applicable)
of the resolution, or upon any 
date specified in the resolution as 
the date upon which the 
certificate is to be filed, or upon  Print Name
the expiration of any period 
specified in the resolution as the 
period within which the certificate 
is to be filed,whichever is latest, 
in which event the certificate of    Signature
dissolution may be signed by any 
three voting members and shall 
set forth a statement that the 
                                     By (if applicable)
persons signing the certificate are 
voting members and are filing the 
certificate because of the failure 
of the officers to do so.            Print Name
 
If authorized representative is an 
individual,then they must sign in 
the "signature"box and print their 
name in the "Print Name" box.        Signature
 
If authorized representative is a 
business entity,not an individual, 
then please print the business       By (if applicable)
name in the "signature" box, an 
authorized representative of the 
business entity must sign in the 
"By" box and print their name in     Print Name
the"Print Name" box.
Form 560                                       Page 4 of 6                                     Last Revised: 02/2023

Complete the information in this section.

                                                AFFIDAVIT
                           In lieu of dissolution releases from various governmental authorities.

                                                Name of Corporation

The undersigned, being first duly sworn, declares that on the dates indicated below, each of the named state governmental 
agencies was advised IN WRITING of the scheduled date of filing of the Certificate and was advised IN WRITING of the 
acknowledgement by the corporation of the applicability of the provisions of section 1702.55 of the ORC. 

Agency                      Date Notified       Agency                                                           Date Notified 
                            (MM/DD/YYYY)                                                                         (MM/DD/YYYY)
Ohio Department of Taxation                     Ohio Job & Family Services 
Dissolution Section                             Status and Liability Section 
4485 Northland Ridge Blvd.                      Data Correspondence Control 
Columbus, Ohio  43229                           Fax:        614-752-4811 
                                                Phone:  614-466-2319
                                                Overnight Address:                       Regular Address: 
                                                P.O. Box 182413                          P.O. Box 182413 
                                                Columbus, OH 43218-2413                  Columbus, OH 43218-2413

Note: This affidavit  must be signed by the person executing the certificate or by an officer of the corporation.

Signature                                                                Title

Name

Mailing Address

City                                                                                     State                   ZIP Code

State of

County of

Sworn to or affirmed and subscribed before me by
                                                Name of person making oath or affirmation

                            on this date
                                                Today's Date (MM/DD/YYYY)
         NOTARY SEAL

                                                Notary Public’s Signature

                                                Expiration Date of Notary’s Commission (MM/DD/YYYY)

Form 560                                        Page 5 of 6                                        Last Revised: 02/2023

                      Instructions for Certificate of Dissolution

This form should be used for a nonprofit, domestic corporation to file a certificate of dissolution pursuant 
to Ohio Revised Code section 1702.47. 
 
Corporation Information 
Please provide the name of the corporation and the charter number assigned by our office.  
 
Also, please provide the location of the principal office in Ohio including the city and county. 
 
Director and Officer Information 
Please provide the names and addresses of the directors and officers of the corporation.   
 
Statutory Agent Information 
Please provide the name and address of the current or new statutory agent. If appointing a new agent, 
the agent must sign the accept the appointment. 
 
Date of Dissolution 
Pursuant to Ohio Revised Code section 1702.47(H), the date of dissolution must be on the date of filing 
with our office, or a later date specified that is not more than 90 days after the date of filing. 
 
Statement of Manner and Basis for Dissolution  
Pursuant to Ohio Revised Code section 1702.47(E)(3), the certificate must provide a statement of the 
manner of adoption of the resolution of dissolution, and in the case of its adoption by the directors, a 
statement of the basis of the adoption. Please check the appropriate box to state the resolution of 
adoption was adopted by the Directors or Members. If adopted by Directors, please check one of the 
four boxes to state the basis for the adoption, as stated in Ohio Revised Code section 1702.47(C).   
 
Additional Provisions 
If the information you wish to provide for the record does not fit on the form, please submit additional 
provisions on a single-sided, 8 ½ x 11 sheet(s) of paper.   
 
Signature(s) 
After completing all information on the filing form, please make sure that page 3 is signed by an 
authorized officer, pursuant to Ohio Revised Code section 1702.47.    
 
**Note:  Our office cannot file or record a document which contains a social security number or 
tax identification number. Please do not enter a social security number or tax identification 
number, in any format, on this form.   

Form 560                               Page 6 of 6                    Last Revised: 02/2023