Application For Certificate Of Withdrawal For Foreign Cooperative Association - Dcra
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1Version 2; 04-30-09
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District of Columbia Government
Corporations Division
PO Box 92300
Washington DC 20090
Application for Certificate of Withdraw
al for Foreign Cooperative Association
Use this form to withdraw Foreign Cooperative Association from the District of Columbia.
ENTITY TYPE
FILING FEE
Foreign Cooperative Association
$6, payable to DC Treasurer
Under the provisions of the District of Columbia Official Code and the Cooperative Association Act, the cooperative association
below hereby applies for a Certificate of Withdrawal and for that purpose submits the following statement:
1. Entity Name
2. Incorporated under the laws of which state or country
3. By signing this form, you affirm that
d
the Cooperative Association is not transacting business in the District of Columbia an
surrenders its authority to transact business in the District.
4. Main address of cooperative association
5. Select the corporate officer executing this form
6. Signature
President
Vice-President
7. Select corporate officer executing this form
8. Signature
Secretary
Assistant Secretary
If you sign this application, you agree that you understand that anyone who makes a false statement anywhere on it can be
punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405.
Mail all forms and required payment to:
Department of Consumer and Regulatory Affairs
Corporations Division
PO Box 92300
Washington, DC 20090
Phone: (202) 442-4400
Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an
organization, to search registered organizations, and to download forms and documents. Just click on "Corporate Registrations."
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