Foreign Business Corporation - Withdrawal And Final Report Application Form
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FILING FEE
See Page 3
for filing fee
OPTIONAL EXPEDITED
+ $25.00
SERVICE
State of Wisconsin
Sec. 180.1520
DEPARTMENT OF FINANCIAL INSTITUTIONS
Wis. Stats.
Division of Corporate & Consumer Services
FOREIGN BUSINESS CORPORATION – WITHDRAWAL AND FINAL REPORT
APPLICATION
(Note: This application consists of four sections, the statement in item 1, the final report, item 2, the fee
computation in item 3, and the execution section, item 4, all of which must be completed.)
1
. APPLICATION FOR WITHDRAWAL
, a foreign corporation
(Corporation Name)
organized under the laws of
and holding a certificate of authority to
(State/Country)
transact business in Wisconsin, hereby surrenders that authority, applies for a Certificate of
Withdrawal, and states:
A. The corporation is not transacting business in Wisconsin.
B. The authority of its registered agent to accept service of process on its behalf is hereby revoked.
C. The corporation hereby consents to service of process under sec. 180.1510(3) and (4) in any civil,
criminal, administrative or investigatory proceeding based on a cause of action arising during the time it
was authorized to transact business in Wisconsin.
D. The mailing address of the corporation’s principal office, if different from that shown on it’s most
recent annual report, is:
Street Address
PO Box
City
State/Province
Country
Zip/Postal Code
E. The corporation agrees to notify the Department of Financial Institutions of any future change in the
mailing address of its principal office.
24
DFI/CORP/
(03/15)
1
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