Application For Certificate Of Withdrawal Form - Secretary Of State Office
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1APPLICATION FOR
Secretary of State Office
500 E Capitol Ave
CERTIFICATE OF WITHDRAWAL
Pierre, SD 57501
(605)773-4845
Clear Form
FOREIGN BUSINESS CORPORATION
Please Type or Print Clearly in Ink
HELP
Original
Photocopy
Please submit one
and one
FILING FEE: $10
SECRETARY OF STATE
payable to
Telephone # ____________________
FAX #
_______________________
1. The name of the corporation is _____________________________________________________________________
______________________________________________________________________________________________
Note: This must be the exact corporate name.
2. It is incorporated under the laws of the state of _________________________________________________________
3. It is not transacting business in this state and it surrenders its authority to transact business in this state.
4. It revokes the authority of its registered agent to accept service on its behalf.
5. The address of its principal office (this is the address of the executive offices of the corporation),
______________________________________________________________________________________________
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional)
City
State
ZIP+4
The application must be signed by an authorized officer of the corporation.
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
foreignapplicationwithdrawal April 2012
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