Form Am 80.200 - Notice Of Withdrawal For A Foreign Corporation Qualified To Do Business
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1ROSS MILLER
Secretary of State
204 North Carson Street, Ste 1
Carson City, Nevada 89701-4299
(775) 684 5708
Website: secretaryofstate.biz
Foreign Withdrawal
(PURSUANT TO NRS 80.200)
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
Notice of Withdrawal
For a Foreign Corporation Qualified to do Business in Nevada
(Pursuant to NRS 80.200)
1. Name of foreign corporation:
2. Modified name (if foreign qualification filed pursuant to 80.025):
3. State or country of incorporation:
4. The corporation hereby notifies the Secretary of State of Nevada of its intention to surrender its
right to transact business and withdraw from the State of Nevada.
5. By authority of a resolution of the board of directors of said corporation, this notice of withdrawal
is executed by the proper officers thereof.
6. Signature of authorized officer
(If more than one signature, attach a plain 8 1/2" x 11" sheet of paper with
:
additional signatures)
X
Signature
Title
Date
FILING FEE:
Corporate Seal
For-Profit Corporations: $75.00
Non-Profit Corporations: $50.00
IMPORTANT: Failure to include any of the above information and submit with the proper fees may
cause this filing to be rejected.
This form must be accompanied by appropriate fees.
Nevada Secretary of State AM 80.200 Withdrawal 2007
Revised on 01/01/07
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