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Form Cf:0025a - Foreign Business Application For Withdrawal By Duly Authorized Officer Page 2

FOREIGN BUSINESS

APPLICATION FOR WITHDRAWAL

DULY AUTHORIZED OFFICER

Pursuant to A.R.S. §10-1521

This form is to be used only for foreign corporations that have not issued stock or have not

conducted business, and that if they have done either, they need to complete form CF0025.

The undersigned, for the purpose of surrendering its authority to transact business in the state of Arizona

pursuant to Title 10, Section §10-1521, does hereby execute this application.

The name of the foreign corporation in the State:of Arizona

______________________________________________________________________

The name of the state or country of its incorporation: ____________________________

Check all that apply:

(One box is required)

None of the corporation’s shares have been issued in the State of Arizona.

The corporation has not commenced business in the State of Arizona.

No debt of the corporation acquired in the State of Arizona remains unpaid.

A majority of the duly authorized officer’s authorized the withdrawal.

The foreign corporation revokes the authority of its statutory agent to accept service on its

behalf and appoints the commission 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 this state.

A mailing address to which the commission may mail a copy of any process served on the

commission pursuant to its appointment as the foreign corporation’s agent for service of

process.

Address: ________________________________________________________________

City _____________________________ , State: __________________, Zip _________

The corporation will notify the Arizona Corporation Commission in the future of any change

in the foreign corporation’s mailing address.

Dated this ________day of ________________________, ___________

Executed by: Duly authorized officer ____________________________

[Print Name/Title]

Signature: ___________________________

CF:0025A Foreign

Arizona Corporation Commission

Page 2 of 2

Rev.10/2009

Corporations Division

Form Cf:0025a - Foreign Business Application For Withdrawal By Duly Authorized Officer Page 2