Form C025.001 - Application For Withdrawal - 2010
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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.
APPLICATION FOR WITHDRAWAL
Read the Instructions
C025i
1.
ENTITY NAME – give the exact name of the corporation as currently shown in A.C.C. records:
_________________________________________________________________
_________________________________________________
2.
A.C.C. FILE NUMBER:
Find the A.C.C. file number on the upper corner of filed documents OR on our website at:
3.
FOREIGN DOMICILE – list the state or country in which the foreign corporation is
incorporated:
______________________________________________________________________________________________________________________________________________________________
4.
TAX CLEARANCE CERTIFICATE (Certificate of Compliance) – check only one box (see
Instructions C025i
for more information):
4.1
This withdrawal WILL require a Certificate of Compliance from the Arizona
Department of Revenue because either the for-profit foreign corporation has transacted
business or issued shares in Arizona, or the nonprofit foreign corporation has conducted
affairs in Arizona.
4.2
This withdrawal WILL NOT require a Certificate of Compliance from the Arizona
Department of Revenue because either the for-profit foreign corporation has not
transacted business or has not issued shares in Arizona, or the nonprofit foreign
corporation has not conducted affairs in Arizona.
5.
The FOR-PROFIT foreign corporation certifies under penalty of perjury by the signature
appearing below that either it did not commence or it is not transacting business in Arizona, and
certifies under penalty of perjury that it surrenders its authority to transact business in Arizona.
6.
The NONPROFIT foreign corporation certifies under penalty of perjury by the signature
appearing below that either it did not commence or it is not conducting affairs in Arizona, and
certifies under penalty of perjury that it surrenders its authority to conduct affairs in Arizona.
7.
By the signature appearing below, the foreign corporation (for-profit or nonprofit) hereby
revokes the authority of its statutory agent to accept service on its behalf and appoints the
Arizona Corporation Commission as its agent for service of process in any proceeding based on a
cause of action arising during the time it was authorized to transact business or conduct affairs
in this state.
C025.001
Arizona Corporation Commission – Corporations Division
Rev: 2010
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