08-456 (Rev. 02/01/2012) Certificate of Withdrawal Instructions CERTIFICATE OF WITHDRAWAL Foreign Nonprofit Corporation AS 10.20.565 Filing Fee: $25.00 (non-refundable) INSTRUCTIONS (Please retain for your records): NOTICE: The Certificate of Withdrawal will not be filed if a biennial report is due or the signatures do not match what the Corporations Section has on record. Please verify the following before completing the application. o Have all current biennial reports be filed? o Are the officers/directors up to date on our records? To verify this information please search for the entity by going to Search Corporations Database in the Corporations Section of our website at www.commerce.alaska.gov/occ . If there is a biennial report due, the report may be filed online by selecting Biennial Reports on the Corporations Section page. If the officers/directors have changed, but no biennial report is due, please submit a Notice of Change located in the Forms and Fees section. Refer to Alaska Statutes 10.06.780. Pursuant to Alaska Statutes 10.20.565, a foreign nonprofit corporation may apply for a Certificate of Withdrawal. If you need assistance in completing your filing, it is advised that you seek legal counsel. Please be aware that this filing will become public information. ITEM 1: Provide the name of the entity currently on record and the Alaska Entity Number. ITEM 2: Provide the state or country of domicile where the corporation has filed their Articles of Incorporation. ITEM 3-6: These are standard statements required by statute. Please read through and verify. ITEM 7: Provide the mailing address where the commissioner may mail any service of process against the corporation. ITEM 8: The Application of Withdrawal must be signed by the corporation222s president or vice president and by the secretary or assistant secretary. NOTE: Persons who sign documents filed with the commissioner that are known to the person to be false in material respects, is guilty of a class A misdemeanor. Mail the Certificate of Withdrawal and the non-refundable $25.00 filing fee in U.S. dollars to: State of Alaska, Corporations Section, PO Box 110806, Juneau, AK 99811-0806 STANDARD PROCESSING TIME for complete and correct applications submitted to this office is approximately 10-15 business days. All applications are reviewed in the date order they are received. State of Alaska Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110806 Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Website: www.commerce.alaska.gov/occ American LegalNet, Inc. www.FormsWorkFlow.com 08-456 (Rev. 06/07/2018) Page 1 of 1 State of Alaska Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110806 Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Website: www.commerce. alaska.gov /occ DO NOT STAMP ABOVE THIS BOX Office Use Only CORP CERTIFICATE OF WITHDRAWAL Foreign Nonprofit Corporation AS 10. 20.565 $25.00 Filing Fee (non-refundable) Pursuant to Alaska Statutes 10.20.565, the undersigned nonprofit applies for a Certificate of Withdrawal. ITEM 1: Name of the Entity: Alaska Entity #: ITEM 2: State or country of domicile: ITEM 3: The nonprofit is not transacting business in Alaska. ITEM 4: The nonprofit surrenders its authority to transact business in Alaska. ITEM 5: The nonprofit hereby revokes its authority to transact business in Alaska. ITEM 6: The nonprofit hereby revokes the authority of its registered agent in Alaska and consents that service of process may subsequently be made on the company by service of the Commissioner of the department. ITEM 7: The mailing address where the Commissioner may mail any service of process against the corporation: Name: Mailing address: Physical address: ITEM 8: The Application of Withdrawal must be signed by the corporation222s president or vice president and by the secretary or assistant secretary. If the same person holds two of these positions, two different people must sign the application, unless that person holds all positions. Signature of President or Vice President Printed name of President or Vice President Date Signature of Secretary or Assistant Secretary Printed name of Secretary or Asst. Secretary Date Mail the Certificate of Withdrawal and the non-refundable $25.00 filing fee in U.S. dollars to: State of Alaska, Corporations Section, PO Box 110806, Juneau, AK 99811-0806 STANDARD PROCESSING TIME for complete and correct applications submitted to this office is approximately 10-15 business days. All applications are reviewed in the date order they are received. American LegalNet, Inc. www.FormsWorkFlow.com 08-561 (Rev. 02/01/2012) Page 1 of 1 State of Alaska Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110806 Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Website: www.commerce.alaska.gov/occ DO NOT STAMP ABOVE THIS BOX Office Use Only CORP CONTACT INFORMATION SHEET Please return this document with your filing. This information will only be used to resolve questions with the filings attached. NOTE: this form will not be filed for record or appear online. Name of entity as it appears on filing: To resolve questions with this filing, contact: Name: Email: Phone: Mailing address: Return documents to: Name: Company: Mailing address: Attach this form to your filings. Send all documents to: State of Alaska, Corporations Section, PO Box 110806, Juneau, AK 99811-0806 STANDARD PROCESSING TIME for complete and correct applications submitted to this office is approximately 10-15 business days. All applications are reviewed in the date order they are received. American LegalNet, Inc. www.FormsWorkFlow.com All major credit cards are accepted. For security purposes, do not email credit card information. Include this credit card payment form with your application. Name of Applicant or Licensee: Program Type: License Number (if applicable): I wish to make payment by credit card for the following (check all that apply): AMOUNT Application Fee: License or Renewal Fee: Other (name change, wall certificate, fine, duplicate license, exam, etc.): 1. 2. TOTAL: Name (as shown on credit card): Mailing Address: Phone Number: Email (optional): Signature of Credit Card Holder: 08-4438 Rev 12/26/18 Credit Card Payment Form (all major cards accepted) State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing PO Box 110806, Juneau, AK 99811 Phone: (907) 465-2550 Credit Card Payment Form CREDIT CARD INFO: Your payment cannot be processed unless all fields are completed! All four fields MUST be completed! This section will be destroyed after the payment is processed. 1. Account Number : 2. Expiration Date: 3. Billing ZIP Code: 4 . Security Code : FOR DIVISION USE ONLY T HE S TATE ALASKA of Department of Commerce, Community , and Economic Development Division of Corporations, Business and Professional Licensing American LegalNet, Inc. www.FormsWorkFlow.com