FORM: CERTIFICATE OF WITHDRAWAL

State of Vermont
Office of the Secretary of State
Printout form: CERTIFICATE OF WITHDRAWAL (foreign profit or non-profit corporation and foreign LLC company)

THIS IS A WORLD WIDE WEB PUBLICATION OF THE VERMONT SECRETARY OF STATE
(If you are reading a paper version of this document, you may find the original at www.sec.state.vt.us)
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The form below can be printed out by hitting "Print" on your web browser. Web pages tend to print out in a long format; therefore, a more compact version of this form can be saved and printed out in the following standard word processor formats:

fcwithdr.doc -- DOC -- Microsoft Windows, Word, WordPad format
fcwithdr.wpd -- WPD -- WordPerfect Document format
fcwithdr.rtf -- RTF -- Rich Text Format
fcwithdr.txt -- TXT -- simple text format
VERMONT SECRETARY OF STATE
Location: 81 River Street Mail: 109 State Street
Montpelier, VT 05609-1104 (802) 828-2386
Email: biz@sec.state.vt.us
APPLICATION FOR CERTIFICATE OF WITHDRAWAL
(foreign profit or non-profit corporation and foreign LLC company)
______________________________________________________________________________
(full name as registered in Vermont)
Incorporated or organized under the laws of the state (country) of_______________________
is no longer transacting business in Vt and surrenders its authority to transact business.
It hereby revokes the authority of its registered agent to accept service on its behalf and appoints the 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 or was transacting without authorization, in this State.
The mailing address where service of process may be sent is:
________________________________________________________________________________
(street) (city) (state) (zip)
The foreign corporation will notify the Secretary of State, for the next seven years, of any change in its mailing address.
All corporate taxes and fees due the State of Vermont have been paid.
Signature______________________________Title________________Date________________
THIS APPLICATION MUST BE TYPED OR PRINTED AND FILED IN DUPLICATE.
$5.00FILING FEE MUST BE ATTACHED.

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State of Vermont Office of the Secretary of State

State of Vermont
Office of the Secretary of State