Form Fc-4 - Application For Withdrawal, Foreign Corporation Page 2
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1
2
3STATE OF HAWAII
FORM FC-4
Nonrefundable Filing Fee:
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
7/2011
Profit: $25.00
Business Registration Division
Nonprofit: $10.00
335 Merchant Street
*FC4*
No personal or business checks
Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810
accepted. See instructions.
Phone No. (808)586-2727
Clear Form
APPLICATION FOR WITHDRAWAL, FOREIGN CORPORATION
(Section 414-451, 414D-282, Hawaii Revised Statutes)
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK
The undersigned, duly authorized officers of the corporation submitting this application, certify as follows:
1.
The corporation is (check one):
Profit
Nonprofit
(F/$25/B24)
(F/$10/B24)
2.
The name of the corporation is:
3.
The corporation was incorporated in:
4.
The corporation is not transacting business, and surrenders its authority to transact business in the State of Hawaii.
5.
The corporation revokes the authority of its registered agent in the State of Hawaii to accept service of process and consents
that service of process in any action or proceeding based upon any cause of action arising in this State during the time the
corporation was authorized to transact business in this State may hereafter be made on such corporation by service thereof
on the Director of Commerce and Consumer Affairs.
6.
The complete mailing address to which the director may mail a copy of any process against the corporation that may be
served on the director is:
We certify under the penalties of Section 414-20, 414D-12, Hawaii Revised Statutes, as applicable, that we have read the above
statements, we are authorized to sign the application, and that the above statements are true and correct.
Signed this
day of
,
(Type/Print Name & Title)
(Type/Print Name & Title)
(Signature of Officer)
(Signature of Officer)
SEE INSTRUCTIONS ON REVERSE SIDE. Application must be signed by at least one officer of the corporation or by the chairperson of the board of
directors.
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