| Entity Name: | BASIL D. FOSSUM, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 22 Jun 1990 (35 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L82812 |
| FEI/EIN Number | 59-3014004 |
| Address: | 914 B MAR WALT DRIVE, FT. WALTON BEACH, FL 32547 |
| Mail Address: | 914 B MAR WALT DRIVE, FT. WALTON BEACH, FL 32547 |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| Name | Role | Address |
|---|---|---|
| FOSSUM, BASIL D., M.D., P.A. | Agent | 914 B MAR WALT DRIVE, FORT WALTON BEACH, FL 32547 |
| Name | Role | Address |
|---|---|---|
| FOSSUM, CHRISTINE A | Vice President | 914-B MAR WALT DR., FT. WALTON BEACH, FL 32547 |
| Name | Role | Address |
|---|---|---|
| FOSSUM, BASIL D. M.D. | Director | 914-B MAR WALT DRIVE, FORT WALTON BCH, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2009-03-27 | FOSSUM, BASIL D., M.D., P.A. | No data |
| REINSTATEMENT | 2008-08-07 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1992-09-02 | 914 B MAR WALT DRIVE, FT. WALTON BEACH, FL 32547 | No data |
| CHANGE OF MAILING ADDRESS | 1992-09-02 | 914 B MAR WALT DRIVE, FT. WALTON BEACH, FL 32547 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1992-09-02 | 914 B MAR WALT DRIVE, FORT WALTON BEACH, FL 32547 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000836820 | ACTIVE | 1000000244700 | OKALOOSA | 2011-12-16 | 2031-12-21 | $ 60,974.23 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE/CENTRAL COLLECTIONS UNIT, 5050 W TENNESSEE ST, TALLAHASSEE FL323996586 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-04-15 |
| ANNUAL REPORT | 2009-03-27 |
| REINSTATEMENT | 2008-08-07 |
| ANNUAL REPORT | 2006-07-05 |
| ANNUAL REPORT | 2005-03-21 |
| ANNUAL REPORT | 2004-01-12 |
| ANNUAL REPORT | 2003-02-07 |
| ANNUAL REPORT | 2002-04-02 |
| ANNUAL REPORT | 2001-02-02 |
| ANNUAL REPORT | 2000-01-28 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
