Version 1; 04-06-09 District of Columbia Government Corporations Division PO Box 92300 Washington DC 20090 Application for Certificate of Withdrawal for Foreign Business Corporation Use this form to withdraw a foreign business corporation from the District of Columbia. FILING FEE ENTITY TYPE Foreign For-Profit Business Corporation $35, payable to DC Treasurer Under the provisions of Business Corporation Act and Professional Corporation Act (DC Official Code, Title 29, Chapters 1 and 4), the the corporation below applies for a Certificate of Withdrawal of a Proclaimed Foreign Corporation and for that purpose makes statements below: 1. Entity Name 2. State or country whose laws govern Entity's Incorporation 3. By signing this form, you affirm that the Corporation: • Is not transacting business in the District of Columbia and surrenders its authority to transact business in the District. • Revokes the authority of its registered agent in the District to accept service of process and consents that that service in any suit, action or proceeding based on any cause of action in the District while the corporation was authorized to transact business in the District, may f -rom now on -- be made on the corporation by service on the DC Superintendent of Corporations. 4. Mailing address where the Superintendent of Corporations may mail any process against the corporation it may be served (must be corporation's main office address). 5. Select corporate officer executing this form: President 6. Signature: Vice-President If you sign this application, you agree that you understand that anyone who makes a false statement anywhere on it can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405. Mail all forms and required payment to: Department of Consumer and Regulatory Affairs Corporations Division PO Box92300 Washington,DC20090 Phone: (202) 442-4400 For overnight delivery, send to: Corporate Bank of America Attn: DC Government Wholesale Lockbox# 92300 Mail Code: MD4-301-18-04 225 North Calvert Street, 18th floor Baltimore, MD 21202 Please check dcra.dc.gov to view organizations required to register, to search business names, to get step-by-step guidelines to register an organization, to search registered organizations, and to download forms and documents. Just click on "Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com