Form Surc - Certificate Of Surrender - 2017 Page 5
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5SURC
Secretary of State
Certificate of Surrender
(Foreign Qualified Corporation ONLY)
IMPORTANT —
Read Instructions
before completing this form.
There is No Fee for filing a Certificate of Surrender
Copy Fees – First page $1.00; each attachment page $0.50;
Certification Fee - $5.00
Note: For information about Franchise Tax Board final tax return requirements,
go to https://
This Space For Office Use Only
(Enter the exact name of the corporation as it is recorded with the California Secretary of State. Note: If you registered
1. Corporate Name
in California using an assumed name,
see
instructions.)
2. 7-Digit Secretary of State File Number
3. Jurisdiction
(State, foreign country or place where this corporation is formed.)
4. Mailing Address to mail copies of Legal Service
(Enter the complete mailing address where the California Secretary of State may
forward copies of any legal documents against the corporation that are served on the Secretary of State intended for the corporation.)
Mailing Address of Corporation
City (no abbreviations)
State
Zip Code
5. Required Statements
(Do not alter the Required Statements – ALL must be true to file this Certificate of Surrender.)
Statements 5(a) – 5(d) are true:
a) The corporation hereby surrenders its rights and authority to transact intrastate business in the State
of California.
b) The corporation hereby revokes its designation of agent for service of process in California.
c) The corporation consents to process against it in any action upon any liability or obligation incurred
within the State of California prior to the filing of this Certificate of Surrender may be served upon the
California Secretary of State.
d) All final returns required under the California Revenue and Taxation Code have been or will be filed
with the California Franchise Tax Board.
6. Read and Sign Below
(See Instructions.
Office or title not required.)
I am a corporate officer and am authorized to sign on behalf of the foreign corporation.
__________________________________________________________
____________________________________________________
Signature
Type or Print Name
2017 California Secretary of State
SURC (REV 01/2017)
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