Fillable Rev-238 - Out Of Existence/withdrawal Affidavit printable pdf download

DEPARTMENT USE ONLY

REV-238 CM (9-95)

OUT OF EXISTENCE/WITHDRAWAL

COMMONWEALTH OF PENNSYLVANIA

AFFIDAVIT

DEPARTMENTOF REVENUE

BUREAU OF COMPLIANCE

BUSINESS CLEARANCE SECTION

DEPT280947

HARRISBURG, PA 17128-0947

PLEASE PRINT OR TYPE INFORMATION

TELEPHONE NUMBER (717) 783-6052

TDD# (717) 772-2252 (Hearing Impaired Only)

N O T E : T h e r e v e r s e s i d e o f t h i s f o r m m u s t b e c o m p l e t e d . S e c t i o n A p e r t a i n s t o a P A c o r p o r a t i o n o r a f o r e i g n

c o r p o r a t i o n t h a t o p e r a t e d w h o l l y w i t h i n P e n n s y l v a n i a . S e c t i o n B p e r t a i n s t o a l l o t h e r f o r e i g n c o r p o r a t i o n s .

Date of Incorporation or

Certificate of A u t h o r i t y

Account ID

State of Incorporation

Entity ID (EIN)

Name of Corporation/Taxpayer

On this

day of

, 19

before me personally

appeared,

w h o d u l y s w e a r s o r a f f i r m s ; I w a s c o n n e c t e d w i t h t h e a b o v e c o r p o r a t i o n a n d h a v e k n o w l e d g e o f i t s a f f a i r s .

S a i d c o r p o r a t i o n c e a s e d t o t r a n s a c t b u s i n e s s i n P e n n s y l v a n i a o n o r a b o u t

M o n t h

D a y

Year

a n d a l l a s s e t s w e r e s o l d , a s s i g n e d o r d i s t r i b u t e d o n

, a n d s i n c e t h a t t i m e ,

M o n t h

D a y

Ye a r

t h e c o r p o r a t i o n h a s n o t o w n e d a n y p r o p e r t y l o c a t e d i n P e n n s y l v a n i a , n o r m a i n t a i n e d a n o f f i c e t h e r e i n , n o r h a s p e r f o r m e d

a n y s a l e s a c t i v i t y , a n d d o e s n o t i n t e n d t o t r a n s a c t f u r t h e r b u s i n e s s i n t h e C o m m o n w e a l t h .

* I f c o r p o r a t i o n n e v e r t r a n s a c t e d b u s i n e s s o r h e l d a s s e t s i n P e n n s y l v a n i a , p l e a s e u s e t h e w o r d s NEVER TRANSACTED

B U S I N E S S i n p l a c e o f a c e s s a t i o n d a t e .

T h e f i l i n g o f t h i s A ff i d a v i t d o e s n o t a f f e c t t h e s t a t u s o f t h e C e r t i f i c a t e o f I n c o r p o r a t i o n / A u t h o r i t y o f t h i s c o r p o r a t i o n b u t

d o e s p e r m i t t h e D e p a r t m e n t o f S t a t e t o r e l i n q u i s h t h e u s e o f t h e p r e s e n t n a m e o f t h e c o r p o r a t i o n t o a n o t h e r c o r p o r a t i o n .

T h i s a f f i d a v i t i s n o t t o b e f i l e d b y a P A c o r p o r a t i o n u t i l i z i n g i t s P A c h a r t e r t o c o n d u c t b u s i n e s s i n a n o t h e r s t a t e .

O u t o f s t a t e c o r p o r a t i o n s s o l i c i t i n g b u s i n e s s i n P e n n s y l v a n i a a r e s u b j e c t t o t a x a n d s h o u l d f i l e t h i s d o c u m e n t

o n l y u p o n c e a s i n g a c t i v i t y i n P e n n s y l v a n i a .

Sworn to and subscribed before me this

day of

, 19

(Signature of Affiant)

(Notary Public, District Justice, or Authorized Agent,

TITLE:

Department of Revenue)

My commission expires

, 19

(Present address of Affiant)

Telephone Number (