Application For Certificate Of Withdrawal Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Application For Certificate Of Withdrawal Form. This is a Wyoming form and can be use in Corporations Secretary Of State.
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Tags: Application For Certificate Of Withdrawal, Wyoming Secretary Of State, Corporations
Wyoming Secretary of State
State Capitol Building, Room 110
200 West 24th Street
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Fax 307.777.5339
Email: business@state.wy.us
For Office Use Only
Foreign Nonprofit Corporation
Application for Certificate of Withdrawal
Pursuant to W.S. 17-19-1520 of the Wyoming Nonprofit Corporation Act, the undersigned corporation hereby applies
for a Certificate of Withdrawal from the state of Wyoming, and for that purpose submits the following statement:
1. Corporation name:
2. Incorporated under the laws of:
(State or country of incorporation)
3. It is no longer transacting business in the state of Wyoming; and it hereby surrenders its authority to transact
business in the state of Wyoming.
4. It revokes the authority of its registered agent to accept service on its behalf and appoints the Wyoming Secretary
of State 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 in this state.
5. Mailing address to which the Secretary of State may mail a copy of any process served on him under Item 4:
6. It will notify the Secretary of State in the future of any change in its mailing address.
Date:
Signature: ___________________________________________
(mm/dd/yyyy)
(May be executed by Chairman of Board, President or another of its officers.)
Print Name:
Title:
Contact Person:
Daytime Phone Number:
Checklist
Filing Fee: $10.00 Make check or money order payable to Wyoming Secretary of State.
Please submit one originally signed document and one exact photocopy of the filing.
Please review form prior to submitting to the Secretary of State to ensure all areas have been
completed to avoid a delay in the processing of your documents.
FNP-CertificateWithdrawal - Revised 12/2008
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