| Entity Name: | F.O.R.M.E. MEDICAL CENTER WALK IN CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Apr 1997 (28 years ago) |
| Date of dissolution: | 24 Sep 1999 (25 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 1999 (25 years ago) |
| Document Number: | P97000034106 |
| FEI/EIN Number | 593440123 |
| Address: | 27910 US 19 NORTH, CLEARWATER, FL, 33761, US |
| Mail Address: | 27910 US 19 NORTH, CLEARWATER, FL, 33761, US |
| ZIP code: | 33761 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| Name | Role | Address |
|---|---|---|
| LIBERTI FRANK E | Agent | 27910 US 19 NORTH, CLEARWATER, FL, 34621 |
| Name | Role | Address |
|---|---|---|
| LIBERTI FRANK E | Director | 27910 US HWY 19 NO, CLEARWATER, FL, 33761 |
| Name | Role | Address |
|---|---|---|
| EVENSTAD KIRK | President | 27910 US 19 NORTH, CLEARWATER, FL, 33761 |
| Name | Role | Address |
|---|---|---|
| EVENSTAD KIRK | Secretary | 27910 US 19 NORTH, CLEARWATER, FL, 33761 |
| Name | Role | Address |
|---|---|---|
| EVENSTAD KIRK | Treasurer | 27910 US 19 NORTH, CLEARWATER, FL, 33761 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1999-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1998-03-10 | 27910 US 19 NORTH, CLEARWATER, FL 33761 | No data |
| CHANGE OF MAILING ADDRESS | 1998-03-10 | 27910 US 19 NORTH, CLEARWATER, FL 33761 | No data |
| Name | Date |
|---|---|
| DEBIT MEMO | 2000-01-11 |
| REINSTATEMENT | 1999-10-21 |
| ANNUAL REPORT | 1998-03-10 |
| Domestic Profit Articles | 1997-04-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
