Foreign Business Corporation - Withdrawal And Final Report Application Form Page 4
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4FOREIGN BUSINESS CORPORATION
WITHDRAWAL AND FINAL REPORT APPLICATION
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▲ Enter your return address within the brackets above.
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Phone number during the day: (
) ______ -
INSTRUCTIONS CONTINUED (Ref. sec. 180.1520, Wis. Stats. for document content)
1. Enter the name of the corporation and the state in which it is incorporated. If the corporation is
licensed in this state under a fictitious name, provide the fictitious name as well.
A, B & C. These statements are required by sec. 180.1520(2)(b) and (c).
D. If the address of the corporation’s principal office has changed from that indicated on its most
recent annual report, provide the new address in item D.
2. Provide complete information to all items in section 2. Post the figure from line 2 A. (11) to line A. in
section 3.
3. The filing fee is the sum of the base filing fee of $40.00, plus any additional amount that may be due
on an increase in capital representation during the final report period on which fee has not been paid. The
fee computed at the rate of $3.00 per $1,000 (or any part thereof) of the increase. (Note: The Corporation
has, as a result of obtaining a certificate of authority, paid on at least $25,000 of capital representation. It
may have paid more at its initial qualification, or may have paid on increases in capital representation
disclosed on its Foreign Corporation Annual Reports filed over the term of its qualification. If this figure
is unknown to the preparer, call the department and ask for the amount of capital representation on which
the corporation has paid fee. 608-261-7577.)
4. The application is to be executed by an officer of the corporation. Print or type the name and title of
the officer signing the application and the date it was signed.
RESET
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DFI/CORP/
(03/15)
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