Foreign Nonprofit Corporation Certificate Of Withdrawal - Washington Secretary Of State
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Foreign Nonprofit Corporation
See attached detailed instructions
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No Fee for Standard Service
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Expedited Service $50.00
UBI Number:
CERTIFICATE OF WITHDRAWAL
Chapter 24.03 RCW
A Washington State Department of Revenue Clearance Certificate Must Be Attached
SECTION 1
NAME OF CORPORATION: (as currently recorded with the Office of the Secretary of State)
NAME USED IN WASHINGTON STATE: (If different than above)
SECTION 2
STATEMENTS BY THE FOREIGN NON PROFIT CORPORATION:
(please check ALL of the following)
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This corporation is not conducting affairs in Washington State
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This corporation surrenders the authority to conduct affairs in Washington State
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The corporation hereby revokes the authority of its registered agent in Washington 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 Washington during the time the corporation was authorized to conduct affairs in Washington may
thereafter be made on the corporation by service thereof on the Secretary of State of Washington.
SECTION 3
ADDRESS WHERE SERVICE OF PROCESS MAY BE FORWARDED: (REQUIRED)
Address: _______________________________City___________________State
Zip Code_______
SECTION 4
SIGNATURE:
(see instructions page)
This document is hereby executed under penalties of perjury, and is, to the best of my knowledge, true and correct.
X __________________________________________________________________________
Signature
Printed Name and Title of Officer
Date
Phone
*A Washington State Department of Revenue Clearance Certificate Must Be Attached*
Foreign Nonprofit Corporation - Withdrawal
Washington Secretary of State
Revised 07/10
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