PHOENIX OFFICE TUCSON OFFICE 1300 West Washington Phoenix, Arizona 85007-2929 Phone: (602) 542-3026 Toll Free (AZ only): 1-800-345-5819 400 West Congress, Suite #221 Tucson, Arizona 85701-1347 Phone: (520) 628-6560 Toll Free (AZ only): 1-800-345-5819 www.azcc.gov www.azcc.gov ARIZONA CORPORATION COMMISSION CORPORATIONS DIVISION GENERAL FILING INSTRUCTIONS FOR FOREIGN BUSINESS/NON-PROFIT CORPORATION APPLICATION FOR WITHDRAWAL Pursuant to A.R.S. §§ 10-1520 & 10-11520  The Application must be executed and state the name of each person who signs it and the capacity in which each person signs. The document may be executed by either the Chairman of the Board of Directors, President or another authorized officer, or if the corporation is in the hands of a receiver, trustee or other court appointed fiduciary, by that fiduciary.  Pursuant to ARS §§10-1520(D) & 10-11520(D) the application for withdrawal is not considered complete until all fees, penalties and costs required have been paid. Please make sure there are no outstanding annual reports prior to completing the withdrawal.  Deliver the completed original Application and one (1) or more exact copies to the Commission accompanied by the $25.00 (U.S.) filing fee with check made payable to the Arizona Corporation Commission. Expedited filing service is available for an additional $35.00 fee (add $35.00 to the filing fee). (Fees pursuant to A.R.S. §§10-122(A) (16) and 10-3122(A) (16)).  The withdrawal will not be considered complete until the Commission has received a Certificate of Compliance from the Arizona Department of Revenue stating that the tax levied under A.R.S. Title 42, chapter 5, article 1 against the corporation has been paid or that the applicant is not subject to the tax. A duly authorized officer must request the certificate of compliance from the Arizona Department of Revenue.  PUBLICATION is required. Within 60 days after the Commission files (approves) the Application for Withdrawal, you must publish a copy of the document in a newspaper of general circulation in the county of the known place of business in Arizona for three consecutive publications. Do not publish until the document has been approved and filed by the Commission. A list of qualified newspapers will be enclosed with your approval letter and is also available on the Commission website, www.azcc.gov/divisions/corporations. You may file the Affidavit of Publication you will receive from the newspaper, but filing it is not mandatory. The entity may be subject to administrative dissolution if it fails to publish.  You may access a request form at http://www.azdor.gov/Forms/other.asp or send a request to the address listed below. A Power of Attorney form is required if the request is made by anyone other than a corporate officer. Provide your corporate identification number, your employer identification number, and your sales tax license number or the type of business which exempts you from sales tax. The department will respond directly to you within thirty days from your written request and you must deliver the certificate to the Commission in order to complete the withdrawal. SEND YOUR REQUEST FORM TO: For Certificate of Compliance ARIZONA DEPARTMENT OF REVENUE SPECIAL COLLECTION SECTION 1600 WEST MONROE PHOENIX, ARIZONA 85007 For further information, please contact the Customer Phone Bank at (602) 542-3026 in Phoenix or the Tucson office at (520) 628-6560 (Toll Free, AZ Residents only - 800 345-5819). CF:0025 Foreign Rev: 09/2009 Page 1 of 2 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR WITHDRAWAL OF FOREIGN CORPORATION Pursuant to A.R.S. §§10-1520 & 10-11520 1. The name of the foreign corporation is: _________________________________________________________________. It is incorporated under the laws of _____________________________________. [State, province or country] 2. The foreign corporation has transacted business/conducted affairs in the State of Arizona and is not currently transacting business/conducting affairs in this state 3. The foreign corporation hereby surrenders its authority to transact business in the State of Arizona. 4. The foreign corporation does hereby revoke the authority of its statutory agent to accept process on its behalf and does hereby appoint the Arizona Corporation Commission 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/conduct affairs in this state. 5. Upon receipt of any process served upon it on behalf of the foreign corporation, the Arizona Corporation Commission is requested to mail a copy to: ________________________________ ________________________________ ________________________________ 6. The foreign corporation will notify the Arizona Corporation Commission in the future of any change in the mailing address of the foreign corporation. This application will not be complete until the Arizona Corporation Commission has received from the Arizona Department of Revenue a notice that all transaction privilege taxes have been paid or are not due and a certificate from the department of revenue that all income tax returns have been filed and taxes paid. Dated this ________ day of ______________________, _______. Signature:_____________________________________________ Printed Name: _____________________ Title: _______________ CF:0025 Foreign Rev: 09/2009 Page 2 of 2 Arizona Corporation Commission Corporations Division American LegalNet, Inc. www.FormsWorkFlow.com