Application For Certificate Of Withdrawal - South Dakota Secretary Of State

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APPLICATION FOR
Secretary of State Office
500 E Capitol Ave
CERTIFICATE OF WITHDRAWAL
Pierre, SD 57501
(605)773-4845
Clear Form
FOREIGN NONPROFIT CORPORATION
Please Type or Print Clearly in Ink
HELP
Original
Photocopy
Please submit one
and one
FILING FEE: $5
SECRETARY OF STATE
payable to
Telephone # _______________________
FAX #
_________________________
Pursuant to the provisions of the South Dakota Business Corporation Act, the undersigned corporation hereby
applies for a Certificate of Withdrawal from South Dakota, and for that purpose submits the following statement:
1. The name of the corporation is _____________________________________________________________________
______________________________________________________________________________________________
2. State or country where incorporated _________________________________________________________________
3. That this corporation is not doing or engaging in any business in this state, and hereby surrenders its authority to
transact business in South Dakota.
4. It revokes the authority of its registered agent in your State to accept service of process, and consents that service of
process in any action, suit or proceeding based upon any cause of action arising in your State during the time the
corporation was authorized to transact business in your State may thereafter be made on the corporation by service
thereof on the Secretary of State of your State.
5. The post-office address to which the Secretary of State may mail a copy of any process against the corporation that
may be served on him is
______________________________________________________________________________________________
Post Office Address
City
State
ZIP+4
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
nonprofitwithdrawal April 2012

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