Form Wfe - Certificate Of Withdrawal - Foreign Business Entity - 2011
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2C
K
OMMONWEALTH OF
ENTUCKY
ELAINE N. WALKER, SECRETARY OF STATE
_________________________________________________________________________________________________________________________
Division of Business Filings
Certificate of Withdrawal
WFE
Business Filings
(Foreign Business Entity)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
_________________________________________________________________________________________________
Pursuant to the provisions of KRS 14A and KRS 271B, 273, 274, 275, 362 or 386 the undersigned applies for a certificate
of withdrawal on behalf of the business entity named below and, for that purpose, submits the following statements:
1. The name of the business entity is __________________________________________________________________.
(The name must be identical to the name on record with the Secretary of State.)
2. The state or country of formation is _________________________________________________________________.
3. The date the business entity was authorized to do business in Kentucky is __________________________________.
4. The Secretary of State may forward to the business entity at the following street address any process served
on the Secretary of State and commits to notify the Secretary of State of any future changes to this address:
_________________________________________________________________________________________________
Street Address (No Post Office Box Numbers)
City
State
Zip Code
5. The business entity is not transacting business in the Commonwealth and surrenders its authority to transact business
in the Commonwealth.
6. The business entity revokes the authority of its registered agent to accept service of process on its behalf and
appoints the Secretary of State as its agent for service of process in any proceeding based on a cause of action arising
during the time it was authorized to transact business in the Commonwealth. The business entity shall notify the Secretary
of State in the future of any change in its mailing address.
7. This application will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date
or the delayed effective date cannot be prior to the date the application is filed. The date and/or time is______________.
(Delayed effective date
and/or time)
I declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct.
_________________________________________________________________________________________________
Signature of Authorized Representative
Printed Name
Date
(04/11)
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