Foreign Business Corporation - Withdrawal And Final Report Application Form Page 3
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43.
COMPUTATION OF FILING FEE
A. The corporation’s highest capital representation in Wisconsin
for the period of the final report (from line 2 A. (11), Section 2) was $ ______________
B. Deduct capital representation on which fee has been paid
(Note: All foreign corporations will have paid fee on not less than $25,000
of capital representation. If this figure is unknown, contact the Department
of Financial Institutions for this information. 608-261-7577)
$ ______________
C. Deduct line 3 B. from line 3 A.
$ ______________
D. If the sum on line 3 C. is positive, compute a fee of $3.00 for each $1,000
(or any part there of ) of such sum and enter the product here. If the sum
in item 3 C. is negative, enter “zero.”
$ ______________
40.00
E. ADD the base filing fee of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
►
F. The sum of line 3 D. and Line 3 E. is the FILING FEE
$ ______________
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. Executed on
(Date)
(Signature)
Title:
President
Secretary
or other officer title
(Printed name)
INSTRUCTIONS (Ref. sec. 180.1520, Wis. Stats. for document content)
Please use BLACK ink. Submit one original along with the required filing fees from section 3F above
to the address listed below. Make checks payable to the “Department of Financial Institutions”. Filing
fee is non-refundable. Sign the document manually or otherwise as allowed under Sec. 180.0103(16)
Wis. Stats.
Mailing Address:
Physical Address for Express Mail:
Phone: 608-261-7577
State of WI-Dept. of Financial Institutions
Department of Financial Institutions
TTY: 711
Box 93348
Division of Corporate & Consumer Services
Milwaukee WI 53293-0348
201 W. Washington Ave – Suite 300
Madison WI 53703
NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made with
the department. Information requested may be used for secondary purposes. This document can be made
available in alternate formats upon request to qualifying individuals with disabilities.
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DFI/CORP/
(03/15)
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