FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS WANTS YOU TO KNOW... Business Identity Theft is a broad term that encompasses a wide variety of crimes involving the unauthorized use of a business identity. Small and midsize companies are tempting targets for criminals. 60% of small businesses close within a year of being victims. In an effort to be more business friendly and to heighten security, the Department of State has instituted an e-mail notification process whereby business entities are sent e-mail notices when any changes are made to their records. This e-mail notice will be sent to the previous e-mail address of record. If the change was not authorized by a principal of the business entity, you will be able to notify the Department utilizing a link provided in the e-mail. The 2012 Florida Statutes 817.155 Matters within jurisdiction of Department of State; false, fictitious, or fraudulent acts, statements, and representations prohibited; penalty; statute of limitations.--A person may not, in any matter within the jurisdiction of the Department of State, knowingly and willfully falsify or conceal a material fact, make any false, fictitious, or fraudulent statement or representation, or make or use any false document, knowing the same to contain any false, fictitious, or fraudulent statement or entry. A person who violates this section is guilty of a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. American LegalNet, Inc. www.FormsWorkFlow.com FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Attached is a form to withdraw the authority of a foreign corporation that is transacting business or conducting affairs in Florida. The requirements are as follows: Pursuant to section 607.1520 or 617.1520, Florida Statutes, the attached application should be completed in its entirety. The fees are as follows: Filing Fee Certified Copy (optional) Certificate of Status (additional) (optional) $ 35.00 $ 8.75 $ 8.75 Checks should be made payable to the Florida Department of State. Please complete the attached cover letter and return it with the withdrawal application and fee. Mailing Address: Amendment Section Division of Corporations P.O. Box 6327 Tallahassee, FL 32314 Street Address: Amendment Section Division of Corporations Clifton Building 2661 Executive Center Circle Tallahassee, FL 32301 For further information, you may call (850) 245-6050. CR2E023 (01/13) American LegalNet, Inc. www.FormsWorkFlow.com COVER LETTER TO: Amendment Section Division of Corporations SUBJECT: ___________________________________________________________________ (Name of Corporation) DOCUMENT NUMBER: The enclosed withdrawal application and fee are submitted for filing. Please return all correspondence concerning this matter to the following: (Name of Person) (Firm/Company) (Address) (City/State and Zip code) For further information concerning this matter, please call: _______________________________________ at (_________)__________________________________ (Name of Person) (Area Code & Daytime Telephone Number) Enclosed is a check for the amount: $35 Filing Fee $43.75 Filing Fee & $43.75 Filing Fee & $52.50 Filing Fee, Certificate of Status Certified Copy Certificate of Status & Certified (Additional copy is Copy (Additional copy is enclosed) Enclosed) MAILING ADDRESS: Amendment Section Division of Corporations P.O. Box 6327 Tallahassee, FL.32314 STREET ADDRESS: Amendment Section Division of Corporations 2661 Executive Center Circle Tallahassee, FL. 32301 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION BY FOREIGN CORPORATION FOR WITHDRAWAL OF AUTHORITY TO TRANSACT BUSINESS OR CONDUCT AFFAIRS IN FLORIDA (Name of Corporation) (Document Number of Corporation (if known) (Incorporated Under Laws of) This corporation is no longer transacting business or conducting affairs within the State of Florida and hereby voluntarily surrenders its authority to transact business or conduct affairs in Florida. This corporation revokes the authority of its registered agent in Florida to accept service on its behalf and appoints the Department of State as its agent for service of process based on a cause of action arising during the time it was authorized to transact business or conduct affairs in Florida. The following is a current mailing address for the corporation: (Mailing Address) (City/ State /Zip) The corporation agrees to notify the Department of State in the future of any change in its mailing address. (Signature of a director, president or other officer - if in the hands of a receiver or other court appointed fiduciary, by that fiduciary) (Date) (Typed or printed name of person signing) (Title of person signing) FILING FEE $35 American LegalNet, Inc. www.FormsWorkFlow.com