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Application for Amendment/Withdrawal--Foreign Corporation (Oregon)

This is to amend or withdraw a foreign corporation in Oregon. The form provided here is simply a sample of what the actual Form CR123 looks like


Phone: (503) 986-2200
Fax: (503) 378-4381
Secretary of State
Corporation Division
255 Capitol St. NE, Suite 151
Salem, OR 97310-1327


For office use only

Registry Number: ________________________________

Check the appropriate box below:

____ AMENDMENT TO APPLICATION FOR AUTHORITY (Complete only 1, 2, 8, 9)

____ WITHDRAWAL OF AUTHORITY TO TRANSACT BUSINESS (Complete only 3, 4, 5, 6, 7, 8, 9)

Attach Additional Sheet if Necessary
Please Type or Print Legibly in Black Ink


Application for Amendment/Withdrawal--Foreign Corporation

Amendment to Application Only

1) Name Prior to Amendment ___________________________________

2) Amendment (The amendment is as follows.)



Withdrawal of Authority to Transact Business Only

3) Name ___________________________________

4) State or Country of Organization _________________________

5) This Corporation is not transacting business in Oregon, and surrenders its authority to transact business in Oregon.

6) This Corporation 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 business in Oregon.

7) MAILING ADDRESS (The address to which the person initiating any proceeding may mail to this Corporation a copy of any process served on the Secretary of State. The Corporation will notify the Corporation Division, Business Registry of any change in this mailing address for a period of five years from the date of this withdrawal.)

Address ____________________________________

City ____________________________________

State ____________________________________

Zip ____________________________________

8) Execution

Printed Name ____________________________________

Signature ____________________________________

Title ____________________________________

9) Contact Name ____________________________________

Daytime Phone Number--Including Area Code _______________________

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