Form Corp. 48 - Application For Certificate Of Withdrawal Of Foreign Corporation - 2005
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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 Foreign Corporation
(Submit with filing fee of $25)
The undersigned corporation, for the purpose of withdrawing from the State of Missouri hereby executes the following document:
1.
The name of the Corporation is:______________________________________________________________________________
and is organized and exists under the laws of:___________________________________________________________________
2.
A.
The corporation is not transacting business and surrenders its authority to transact business in the State of Missouri.
B.
The corporation revokes the authority of its registered agent in Missouri to accept service of process and consents that
service of process in any suit, action, or proceeding based upon any cause of action arising in Missouri during the time
the corporation was licensed to transact business in Missouri may thereafter be made on the corporation by service on
the Secretary of State of Missouri.
C.
The mailing address to which the Secretary of State may mail a copy of any process is:
_________________________________________________________________________________________________
Address
City/State/Zip
D.
The corporation will notify the Secretary of State of Missouri of any future change of mailing address for a period of
five years.
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)
________________________________________________________________________________________________________________
Auhorized Signature
Printed Name
Title
month/day/year
Name and address to return filed document:
Name: __________________________________________
Address: _________________________________________
City, State, and Zip Code: __________________________
Corp. 48 (01/05)
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