Application For Withdrawal Of Certificate Of Authority Form. This is a Georgia form and can be use in Corporation Secretary Of State.
Tags: Application For Withdrawal Of Certificate Of Authority, Georgia Secretary Of State, Corporation
Office Of The Secretary Of State Corporations Division 315 West Tower # 2 M.L. King Jr. Dr. SE Atlanta, GA 30334-1530 (404) 656-2817 www.georgiacorporations.org Karen C. Handel Secretary Of State Chauncey Newsome Director Application For Withdrawal Of Certificate Of Authority 1. Organization Type (check one only) Corporation Limited Liability Company Limited Partnership Limited Liability Partnership a) _________________________________ Entity Control No. 2. Entity Name _____________________________________________________________________ 3. Home State/Country (State/Country in which entity was formed) _____________________________ 4. The entity selected in item 1. and named in item 2. no longer transacts business in Georgia and surrenders its certificate of authority 5. The entity revokes the authority of its registered agent to accept service of process on its behalf and appoints the Secretary of State of Georgia as its agent for service in any proceeding based on a cause of action that arose during the time it was authorized to transact business in Georgia. 6. Any process served on the entity after withdrawal from Georgia may be mailed to the following address: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 7. The withdrawing entity commits that it will notify the Secretary of State of any change in the mailing address provided in item 6. 8. ______________________________________________________________________________ Signature ______________________________________________________________________________ Printed name of signer Title of Person signing above (Check one only) Corporation LLC LP LLP Attorney in fact Officer, Receiver or trustee Member, Manager, Organizer, Receiver or Trustee General Partner, Receiver or Trustee General Partner, Receiver or Trustee Entities must have a status of at least “Active Compliance” or “Active/Owes Current Year” in order to withdraw. If entity status is “Active/Non Compliance”, the annual registration must be submitted before withdrawal. The annual registration may be filed online. There is no filing fee requirement for this form. Please mail completed application to the address at the top of this form. Certificate of withdrawal will me mailed to the address in item 6 unless a preferred address is provided in a cover letter. American LegalNet, Inc. www.FormsWorkflow.com