Application For Withdrawal Of Certificate Of Authority - Georgia Secretary Of State
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1Office Of The Secretary Of State
Brian P. Kemp
Corporations Division
Secretary Of State
237 Coliseum Drive
Macon, GA 31217
(404) 656-2817
sos.georgia.gov/corporations
Application For Withdrawal Of Certificate Of Authority
1.
Organization Type (check one only)
Corporation
Limited Liability Company
Limited Partnership
Limited Liability Partnership
a) _________________________________
.
Entity Control No
2.
Entity Name _____________________________________________________________________
3.
Home State/Country (State/Country in which entity was formed) _____________________________
4.
The entity selected in item 1. and named in item 2. no longer transacts business in Georgia and
surrenders its certificate of authority
5.
The entity revokes the authority of its registered agent to accept service of process on its behalf and
appoints the Secretary of State of Georgia as its agent for service in any proceeding based on a cause
of action that arose during the time it was authorized to transact business in Georgia.
6.
Any process served on the entity after withdrawal from Georgia may be mailed to the following address:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
7.
The withdrawing entity commits that it will notify the Secretary of State of any change in the mailing
address provided in item 6.
8.
______________________________________________________________________________
Signature
______________________________________________________________________________
Printed name of signer
Title of Person signing above (Check one only)
Corporation
- Officer, Receiver or trustee
LLC
- Member, Manager, Organizer, Receiver or Trustee
LP
- General Partner, Receiver or Trustee
LLP
- General Partner, Receiver or Trustee
Attorney in fact
Entities must have a status of at least “Active Compliance” or “Active/Owes Current Year” in order to withdraw. If entity status is
“Active/Non Compliance”, the annual registration must be submitted before withdrawal. The annual registration may be filed
online. There is no filing fee requirement for this form. Please mail completed application to the address at the top of this
.
form. Certificate of withdrawal will be mailed to the address in item 6 unless a preferred address is provided in a cover letter
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