Application For Withdrawal - Utah Department Of Commerce
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Entity Number: __________________
State of Utah
DEPARTMENT OF COMMERCE
[ ] Profit Corporation
Division of Corporations & Commercial Code
Application for Withdrawal
[ ] Non-Profit Corporation
Print Form
Clear Form
__________________________________________________________________________________________
Exact Corporate Name
SPECIAL NOTE: Utah law requires corporations seeking withdrawal to submit a Tax Clearance Certificate with
the Application for Withdrawal. Please inquire with the Utah State Tax Commission at 210 N 1950 W Salt Lake
City, Utah 84134. Phone: (801) 297-2200 or Toll Free: (800) 662-4335.
Pursuant to the provisions of Utah Law, the undersigned corporation hereby submits this Application for
Withdraw from the State of Utah, and for that purpose submits the following statement:
First:
Corporation Name is ___________________________________________________________________
Second:
It is incorporated under the laws of the state of ______________________________________________
Third:
It is no longer transacting business in Utah.
Fourth:
It hereby surrenders its authority to transact business in Utah.
Fifth:
Service of process in any action, suit or proceeding based upon any cause of action arising in Utah during
the time the corporation was authorized to transact business in Utah may thereafter be made on the
corporation by service thereof on the (check one):
[ ]
Registered Agent of Record (For Profit Corporations Only)
Name_______________________________________________________________________________
Address___________________________________ City ________________ State ____ Zip__________
(Utah Street Address Required, PO Boxes can be listed after the street address)
[ ]
The Principal Office
Address___________________________________ City ________________ State ____ Zip__________
Under penalties of perjury, I declare that this Application for Withdrawal, and the accompanying Tax Clearance
Certificate, has been examined by me and is, to the best of my knowledge and belief, true, correct and complete.
Dated this ____________ day of ______________________________________ , 20_______
Authorized party must sign here after the form is printed
By: ________________________________________________ Title: __________________________________
Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes,
you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. Ent
Mailing/Faxing Information:
Division's Website:
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