Foreign Non-Profit Corporation Application For Certificate Of Withdrawal Form

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DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS
BUSINESS REGULATION ADMINISTRATION
CORPORATIONS DIVISION
941 NORTH CAPITOL STREET, N.E.
Government
WASHINGTON, D.C. 20002
of the
District of Columbia
NOTE:
THIS IS A SPECIMEN FORMAT FOR APPLICATION FOR CERTIFICATE OF WITHDRAWAL.
YOU MUST DRAFT YOUR OWN APPLICATION ON PLAIN BOND PAPER TO BE SUBMITTED
IN DUPLICATE ORIGINAL (TWO MANUAL SETS).
DO NOT FILL IN THIS FORMAT
FOREIGN NON-PROFIT CORPORATION APPLICATION
FOR CERTIFICATE OF WITHDRAWAL GUIDELINE
APPLICATION FOR CERTIFICATE OF WITHDRAWAL OF
_______________________________________________________
TO:
DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS
BUSINESS REGULATION ADMINISTRATION
CORPORATIONS DIVISION
941 NORTH CAPITOL STREET, N.E.
WASHINGTON, D.C. 20002
Pursuant to the provisions of the District of Columbia Non-profit Corporation Act, the undersigned
corporation applies for a Certificate of Withdrawal from the District of Columbia, and for that purpose
submits the following statement:
FIRST: The name of the corporation is _____________________________________________
SECOND: It is incorporated under the laws of ________________________________________
THIRD: It is not conducting its affairs in the District of Columbia.
FOURTH: It surrenders its authority to conduct its affairs in the District of Columbia.
FIFTH: It revokes the authority of its registered agent in the District of Columbia to accept service of
process, and consents that service of process in any action, suit, or proceeding based upon any cause of
action arising in the District of Columbia during the time the corporation was authorized to conduct it
affairs in the District of Columbia may hereafter be made on the corporation by service thereof on the
Department of Consumer and Regulatory Affairs for the District of Columbia.
SIXTH: The post office address of which the Department of Consumer and Regulatory Affairs,
Washington, D.C. may mail a copy of any process against the corporation that may be served on him is:
______________________________________________________________________________

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