Form Np-113.45 - Application For Certificate Of Withdrawal And Final Report printable pdf download

Form Np-113.45 - Application For Certificate Of Withdrawal And Final Report

NP - 113.45

JESSE WHITE

File #

(Rev. Jan. 1999)

Secretary of State

This space for use by

State of Illinois

Secretary of State

Submit in Duplicate

APPLICATION FOR CERTIFICATE OF

Date

Remit payment in check or money

WITHDRAWAL AND FINAL REPORT

order, payable to “Secretary of State.”

Filing Fee

DO NOT SEND CASH!

Approved

Pursuant to the provisions of “The General Not For Profit Corporation Act of 1986,” the undersigned corporation hereby

applies to withdraw from the State of Illinois and submits the following statement.

The name of the corporation is

The State or county of incorporation is

It surrenders its authority to conduct affairs in Illinois

It revokes the authority of its registered agent in Illinois to accept service of process in any suit, action or proceeding

based upon any cause of action arising in this State during the time this corporation was licensed to conduct affairs

in this State may hereafter be made on such corporation by service thereof upon the Secretary of State.

The post office address to which the Secretary of State may mail a copy of any process served upon him against

the corporation is

Dated _________________________ , ________

____________________________________________

(Month & Day)

(Year)

(Exact name of corporation)

attested by _____________________________________ by _______________________________________

(Signature of Secretary or Assistant Secretary)

(Signature of President or Vice President)

______________________________________ _______________________________________

(Type or print name and title)

(All signatures must be in BLACK INK.)

Form Np-113.45 - Application For Certificate Of Withdrawal And Final Report