Form 08-456 - Certificate Of Withdrawal Form - Division Of Corporations, Business And Professional Licensing

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State of Alaska
DO NOT STAMP ABOVE THIS BOX
Division of Corporations, Business and Professional Licensing
CORP
Office Use Only
CORPORATIONS SECTION
PO Box 110806
Juneau, AK 99811-0806
Phone: (907) 465-2550
Fax: (907) 465-2974
Website:
CERTIFICATE OF WITHDRAWAL
Foreign Nonprofit Corporation
AS 10.20.565
$25.00 Filing Fee (non-refundable)
Pursuant to Alaska Statutes 10.20.565, the undersigned nonprofit applies for a Certificate of Withdrawal.
ITEM 1: Name of the Entity:
Alaska Entity #:
ITEM 2: State or country of domicile:
ITEM 3: The nonprofit is not transacting business in Alaska.
ITEM 4: The nonprofit surrenders its authority to transact business in Alaska.
ITEM 5: The nonprofit hereby revokes its authority to transact business in Alaska.
ITEM 6: The nonprofit hereby revokes the authority of its registered agent in Alaska and consents that service
of process may subsequently be made on the company by service of the Commissioner of the department.
ITEM 7: The mailing address where the Commissioner may mail any service of process against the
corporation:
Name:
Mailing address:
Physical address:
ITEM 8: The Application of Withdrawal must be signed by the corporation’s president or vice president and by
the secretary or assistant secretary.
Signature of President or Vice President
Printed name of President or Vice President
Date
Signature of Secretary or Assistant Secretary
Printed name of Secretary or Asst. Secretary
Date
Mail the Certificate of Withdrawal and the non-refundable $25.00 filing fee in U.S. dollars to:
State of Alaska, Corporations Section, PO Box 110806, Juneau, AK 99811-0806
STANDARD PROCESSING TIME for complete and correct applications submitted to this office is
approximately 10-15 business days. All applications are reviewed in the date order they are received.
08-456 (Rev. 02/01/2012)
Page 1 of 1

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