SOS TC 10/13 APPLICATION FOR TAX CLEARANCE FOR DISSOLUTION/WITHDRAWAL (TYPE OR PRINT LEGIBLY) Date: The exact name of the entity as registered with our office is: Taxation and Revenue ID SUBJECT: Tax Clearance Request for Dissolution/Withdrawal This entity is in the process of dissolving/withdrawing from the State of New Mexico and is requesting tax clearance. FINAL DAY OF BUSINESS: Month Day Year NOTE: The entity cannot be issued a Tax Clearance for a future date or if it is delinquent in filing reports and/or paying fees due. A final report may be required through the final day of business, you will be advised accordingly. Signature of Officer or Authorized Agent NAME: ADDRESS: CITY: ST: ZIP CODE: TELEPHONE: EMAIL ADDRESS: MAIL TO: Secretary of State-Tax Compliance Section 325 Don Gaspar, Suite 300, Santa Fe NM 87501 American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com Certificate of No Tax DueCertificate of ComplianceLetter of Clearance American LegalNet, Inc. www.FormsWorkFlow.com DOCUMENT DELIVERY INSTRUCTION FORM (You must have one Document Delivery Instruction Form for each filing being submitted) Entity Name: Mailing Address (Include city, state and zip code): Contact Name: Contact Phone Number: Contact Email: IF YOU HAVE SELECTED TO PICK UP YOUR DOCUMENTS, OUR OFFICE WILL CONTACT YOU WHEN YOUR DOCUMENTS ARE COMPLETED AND READY FOR PICK UP. DOCUMENTS WILL NOT BE HELD FOR MORE THAN 5 BUSINESS DAYS. IF YOU HAVE NOT PICKED THEM UP WITHIN THAT TIME FRAME, THEY WILL BE MAILED TO THE ADDRESS LISTED ABOVE. PLEASE CONTACT OUR OFFICE AT 800-477-3632 AND NOTIFY US IF YOU ARE NOT ABLE TO PICK THEM UP WITHIN THAT TIME FRAME. ---THANK YOU New Mexico Secretary of State Business Services Division 325 Don Gaspar, Suite 300 267 Santa Fe, NM 87501 (800)477-3632 267 www.sos.state.nm.us Please check how the documents are to be delivered Will Pick Up Mail to Address Above American LegalNet, Inc. www.FormsWorkFlow.com