Form Corp.49 - Application For Certificate Of Withdrawal Of A Foreign Nonprofit Corporation
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1State of Missouri
This form is designed to be filled out online for your
convenience. Enter the data and press print when
Robin Carnahan, Secretary of State
ready. Use the reset button to reset the entire form.
Corporations Division
P.O. Box 778 / 600 W. Main Street, Rm 322
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Jefferson City, MO 65102
Application for Certificate of Withdrawal
of a Foreign Nonprofit Corporation
(Submit with filing fee of $10.00)
(1)
The corporation's name is ___________________________________________________________________________________
and it is organized and existing under the laws of _________________________________________________________________
(2)
The corporation is not transacting business in this state, and it surrenders its authority to transact business in the State of Missouri.
(3)
The corporation revokes the authority of its registered agent to accept service on its behalf and appoints the Missouri 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
do business in the State of Missouri.
(4)
The mailing address to which the Secretary of State may mail a copy of any process is:
_________________________________________________________________________________________________________
Address
City, State, Zip
(5)
The corporation will notify the Secretary of State of any future changes of mailing address.
(6)
The effective date of this document is the date it is filed by the Secretary of State of Missouri, unless you indicate a future
date, as follows: __________________________________________________________________________________________
(Date may not be more than 90 days after the filing date in this Office)
In Affirmation thereof, the facts stated above are true and correct:
(The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575.040, RSMo)
____________________________________________________________________________________________________________
Authorized signature of officer or chairman of the board
Printed Name
Title
Date
Name and address to return filed document:
Name: __________________________________________
Address: _________________________________________
City, State, and Zip Code: __________________________
Corp. 49(01/05)
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