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Application By A Foreign Nonprofit Corporation For An Amended Certificate Of Withdrawal from the State of South Carolina

This is for a certificate of withdrawal of an application for a foreign nonprofit corporation in South Carolina. The form provided here is simply a sample of what the actual Form 107 looks like.

STATE OF SOUTH CAROLINA
SECRETARY OF STATE

APPLICATION BY A FOREIGN NONPROFIT CORPORATION
FOR A CERTIFICATE OF WITHDRAWAL
FROM THE STATE OF SOUTH CAROLINA

TYPE OR PRINT CLEARLY IN BLACK INK

Pursuant to Section 33-31-1520 of the 1976 South Carolina Code of Laws, as amended, the undersigned nonprofit corporation hereby applies for a certificate of withdrawal authorizing it to withdraw from the State of South Carolina and to surrender its authority to transact business in the State of South Carolina. The undersigned hereby appoints the Secretary of State as agent for service of process and commits to notify the Secretary of State of any change in mailing address.

1. The name of the foreign nonprofit corporation as filed in South Carolina:

______________________________________

2. The corporation is incorporated under the laws of:

______________________________________
(State or Country)

3. The corporation received a certificate of authorization to transact business in South Carolina dated:

_________________ Month __________________ Day __________ Year

4. The corporation is no longer transacting business in South Carolina.

5. The corporation hereby surrenders its authority to transact business in the State of South Carolina.

6. The corporation revokes the authority of its registered agent in South Carolina to accept service of process on its behalf and appoints the Secretary of State as its agent for service of process in any action, suit, or proceeding based upon any cause of action arising during the time it was authorized to do business in this State.

7. The address to which the Secretary of State may mail a copy of any process against the Corporation that may be served on him is

_____________________________________

_____________________________________

_____________________________________

8. Unless a delayed date is specified, this application shall be effective upon acceptance for filing by the Secretary of State (See Section 33-31-123(b) of the 1976 South Carolina Code of Laws, as amended):

_____________________________________

Date ______________________

_____________________________________
Name of Corporation

_____________________________________
Signature

_____________________________________
Type or Print Name and Office


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INSTRUCTIONS FOR FILLING IN FORM
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1. Two copies of this application, the original and either a duplicate original or a conformed copy, must be filed.

2. If space on this form is insufficient, please attach additional sheets containing a reference to the appropriate paragraph in this form, or prepare this form by computer disk, which will allow additional space to be included on the form.

3. This application must be accompanied by the filing fee of $10.00, payable to the Secretary of State.

Return to: Secretary of State
PO Box 11350
Columbia SC 29211

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