Withdrawal or Dissolution of a corporation guaranty (Washington)
This form is an application for Department of Revenue Clearance Certificate to withdraw or dissolve a corporation and guaranty in Washington. The form provided here is simply a sample of what the actual form looks like.
WITHDRAWAL OR DISSOLUTION OF A CORPORATION AND GUARANTY
(Application for Department of Revenue Clearance Certificate)
Washington State
Department of Revenue
PO Box 47474
Olympia WA 98504-7474
FEIN No: __________________________
1. Name of Corporation: __________________________
2. Tax Registration No. (UBI No.) (Required): __________________________
__________________________ Street Address
__________________________ City
__________________________ State
__________________________ Zip
3. Principal business location in Washington: __________________________
4. Describe the Washington business activities engaged in: __________________________
5. Date corporation began business in Washington: __________________________
6. Date corporation ceased all business activity in Washington: __________________________
7. Have all excise tax returns been filed and paid for all business activity in Washington through the date stated in Question #6? ____ Yes ____ No
If all excise tax returns have not been filed and paid, the application cannot be processed.
8. If the business is to be carried on by a successor, provide successor's name, address, and Tax
Registration/UBI No.
Name of Successor: __________________________
Tax Registration No. (UBI No.) (Required): __________________________
__________________________ Street Address
__________________________ City
__________________________ State
__________________________ Zip
9. Name and phone number of the person to contact if there are questions regarding this application.
__________________________ Name
Phone: __________________________
Email: __________________________
FAX: __________________________
10. Name, address, and phone number of person to contact if it is necessary to examine the books and records.
Name: __________________________
Phone: __________________________
Street Address __________________________
City __________________________
State __________________________
Zip __________________________
11. Name and address where you would like the Department of Revenue certificate mailed.
Name: __________________________
E-mail address: __________________________
Street Address __________________________
City __________________________
State __________________________
Zip __________________________
I certify that the above information is true and correct. In consideration of the issuance by the Department of Revenue of its certificate certifying that every license fee, tax increase or penalty imposed under Chapter 180, Laws of 1935 has been paid or provided for by said corporation, the undersigned hereby agrees to pay to Department of Revenue, upon its demand, any and all such fee, tax increase or penalty as may hereafter be determined to be unpaid and payable by this corporation.
Signature: __________________________
Title: __________________________
Corporate Name: __________________________
Date: __________________________
Application cannot be processed if not signed and dated.
For tax assistance, visit https://dor.wa.gov or call 1-800-647-7706. To inquire about the availability of this document in an alternate format for the visually impaired, please call (360) 705-6715. Teletype (TTY) users may call 1-800-451-7985.
REV 31 0037e (a) (07/06/06)