Foreign Nonprofit Corporation Application For Certificate Of Withdrawal - 2015
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1Ed Murray
Wyoming Secretary of State
2020 Carey Avenue, Suite 700
For Office Use Only
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Fax 307.777.5339
Email:
Business@wyo.gov
Foreign Nonprofit Corporation
Application for Certificate of Withdrawal
Pursuant to W.S. 17-19-1520 the undersigned corporation hereby applies for a Certificate of Withdrawal from the
state of Wyoming.
1. Corporation name:
2. Incorporated under the laws of:
(State or country)
3. It is no longer transacting business in the state of Wyoming; and it hereby surrenders its authority to transact
business in the state of Wyoming.
4. It revokes the authority of its registered agent to accept service on its behalf and appoints the Wyoming Secretary
of State as its agent for service of process in any proceeding based on a cause of action arising during the time it was
authorized to transact business in this state.
5. Mailing address to which the Secretary of State may mail a copy of any process served on him under Item 4:
6. It will notify the Secretary of State in the future of any change in its mailing address.
Signature: ___________________________________________
Date:
(May be executed by Chairman of Board, President or another of its officers.)
(mm/dd/yyyy)
Print Name:
Contact Person:
Title:
Daytime Phone Number:
Email:
(Email provided will receive filing evidence)
*May list multiple email addresses
Checklist
Filing Fee: $10.00 Make check or money order payable to Wyoming Secretary of State.
Please submit one originally signed document.
Typical processing time is 3-5 business days following the date of receipt in our office.
Please review form prior to submitting to the Secretary of State to ensure all areas have been
completed to avoid a delay in the processing of your documents.
FNP-CertificateWithdrawal - Revised October 2015
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