CERTIFICATE OF WITHDRAWAL
TO TRANSACT
BUSINESS IN THE STATE OF NEBRASKA
, Secretary of State
John A. Gale
Room 1305 State Capitol, P.O. Box 94608
Lincoln, NE 68509
Submit in Duplicate
(returned file stamped copy is your certificate of withdrawal)
________________________________________________________________________
Name of Corporation
Incorporated under the laws of_____________________________desires to withdraw its authority
to transact business in the State of Nebraska.
This corporation is no longer transacting business in the State of Nebraska and surrenders its authority
to transact business in the State of Nebraska.
This corporation revokes the authority of its registered agent to accept service of process on its behalf
and consents that service of process in any proceeding during the time it was authorized to transact
business in the state may be made on this corporation at the following address:
Mailing Address at which process against corporation may be served:
_______________________________________________________________________
Street Address
City
State
Zip
_______________________
DATED
________________________________
Signature
________________________________
Printed Name/Title
NOTE: Every filing must be signed by the chairperson of the board of directors, the president, or one of the officers
of the corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing shall
be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed
fiduciary, the filing shall be signed by that fiduciary.
FILING FEE: $30.00
Revised 12/19/2000
Neb. Rev. Stat. 21-20,178