Application for Certificate of Withdrawal (Washington)
This is an application for a corporate certificate of withdrawal from Washington. The form provided here is simply a sample of what the actual form looks like.
Application for Certificate of Withdrawal
RCW 23B.15.200
(Copies of RCW law may be obtained at local and state libraries.)
Check List
All documents must be typewritten or printed legibly in ink.
□ 1. Name of Corporation.
□ 2. State or country of original incorporation.
□ 3. Statement that corporation surrenders its authority to conduct affairs in Washington.
□ 4. The corporation hereby revokes the authority of its registered agent in Washington to accept service of process, and consents that service of process in any action, suit or proceeding based upon any cause of action arising in Washington during the time the corporation was authorized to conduct affairs in Washington may thereafter be made on the corporation by service thereof on the Secretary of State of the state of Washington.
□ 5. Attach a copy of revenue clearance certificate issued by the Department of Revenue.
□ 6. Address to which copy of any process against the corporation that may be served on the Secretary of State.
□ 7. Commitment to notify the Secretary of State of any changes in the mailing address.
□ 8. Document must be signed by Officer or Chairman of the Board.
□ NO FILING FEE
The original and one (1) or more copies of this application must be delivered or mailed to:
CORPORATION DIVISION
James M. Dolliver Building
801 Capitol Way South
PO Box 40234
Olympia WA 98504-0234
Application for Certificate of Withdrawal
RCW 23B.15.200
UBI #: _______________________
Phone #: _______________________
Pursuant to the provisions of RCW 23B.15.200 the undersigned does hereby submit an application for a Certificate of Withdrawal.
1. Name of the Corporation is: _______________________
2. State or country of original incorporation: _______________________
3. Statement surrendering the corporations authority to conduct affairs in this state: _______________________
4. The corporation hereby revokes the authority of its registered agent in Washington to accept service of process, and consents that service of process in any action, suit or proceeding based upon any cause of action arising in Washington during the time the corporation was authorized to conduct affairs in Washington may thereafter be made on the corporation by service thereof on the Secretary of State of the state of Washington.
5. Attached is a copy of revenue clearance certificate issued by the Department of Revenue.
6. Address in the "home" jurisdiction where service of process can be forwarded is: _______________________
7. The undersigned does hereby commit to notify the Secretary of State of any changes in the mailing address
8. This document is hereby executed under penalties of perjury, and is, to the best of my knowledge, true and correct.
Dated: ________________ 20______.
X_______________________ (Signature of Officer or Chairman of the Board)