Application For Certificate Of Withdrawal - Connecticut Secretary Of State
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1APPLICATION
FOR CERTIFICATE
OF WITHDRAWAL
FOREIGN CORPORATION
Office of the Secretary of the State
30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-0470 / Rev. 12/l 999
Space For Office Use Only
1. NAME OF CORPORATION
IN ITS STATE/COUNTRY
OF FORMATION:
2. IF DIFFERENT
FROM THE ABOVE, THE NAME UNDER WHICH CORPORATION
TRANSACTS
BUSINESS IN CONNECTICUT:
3. STATE OR COUNTRY
OF INCORPORATION:
The corporation
is not transacting
business/conducting
affairs in Connecticut and surrenders its authority
to transact further business/conduct
affairs therein.
The corporation
revokes the authority
of its registered agent to accept service of process on its behalf.
The corporation
appoints the Secretary of the State as its agent for service of process and consents to
service of process thereon in any action, suit or proceeding based on a cause of action arising during the
time it was authorized to transact business/conduct
affairs in this state.
4. THE ADDRESS
TO WHICH
THE SECRETARY
OF THE STATE MAY MAIL
ANY
PROCESS SERVED UPON HIM IN ACCORDANCE
WITH THE ABOVE STATED
APPOINTMENT:
Number and Street or P.O. Box
City, State and Zip Code
The corporation sprees to notifv the Secretary of the State in the future
of any
changes to the above stated address.
5. EXECUTION:
Dated this
day of
,20
.
I
Print or type name of signatory
1
Capacity of signatory
Signature
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