Fillable Department of the Secretary of State APPLICATION FOR (North Carolina Secretary of State)

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Department of the Secretary of State APPLICATION FOR (North Carolina Secretary of State)

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BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July, 2017) (Form BE-08)
State of North Carolina
Department of the Secretary of State
APPLICATION FOR CERTIFICATE OF WITHDRAWAL
Pursuant to §55-15-20 or §55A-15-20 of the General Statutes of North Carolina, the undersigned corporation hereby applies to the
Secretary of State for a Certificate of Withdrawal and for that purpose submits the following statement.
1. The name of the foreign corporation is:_____________________________________________________________________
2. The corporation is organized under the laws of:_______________________________________________________________
3. The corporation is not transacting business or conducting affairs in the State of North Carolina and surrenders its authority to transact
business or conduct affairs in this State.
4. The corporation revokes the authority of its registered agent to accept service of process and consents that service of process in any
action or proceeding based upon any cause of action arising in the State of North Carolina, or arising out of business transacted or
affairs conducted in North Carolina, during the time the corporation was authorized to transact business or conduct affairs in North
Carolina may hereafter be made on such corporation by service thereof on the Secretary of State.
5. The mailing address to which the Secretary of State may mail a copy of any process served on the Secretary of State pursuant to the
paragraph above is:
C/O__________________________________________________________________________________________________
Address_______________________________________________________________________________________________
City, State, Zip Code_____________________________________________________________________________________
6. The corporation hereby agrees to file a statement of any subsequent change in its mailing address with the Secretary of State.
7. This application will be effective upon filing, unless a date and/or time is specified:________________
This the ______day of ___________________ , 20______
____________________________________
Name of Corporation
____________________________________
Signature
____________________________________
Type or Print Name and Title
NOTES
1. Filing fee is $25. This application must be filed with the Secretary of State.
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BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July, 2017) (Form BE-08)
Instructions for Filing
APPLICATION FOR CERTIFICATE OF WITHDRAWAL
(Form BE-08)
Item 1 Enter the complete name of the corporation exactly as it appears on the Certificate of Authority.
Item 2 Enter the state or country of organization
Item 3 See Form.
Item 4 See Form.
Item 5 Enter the complete address to which the Secretary of State may send a copy of any process served
pursuant to the paragraph above.
Item 6 See Form.
Item 7 The document will be effective on the date and at the time of filing, unless a delayed date or an
effective time (on the day of filing) is specified. If a delayed effective date is specified without a
time, the document will be effective at 11:59:59 p.m. on the day specified. If a delayed effective
date is specified with a time, the document will be effective on the day and at the time specified. A
delayed effective date may be specified up to and including the 90
th
day after the day of filing.
Date and Execution
Enter the date the document was executed.
In the blanks provided enter:
♦ The name of the corporation as it appears in Item 1.
♦ The signature of the representative of the corporation executing the document (may be
the chairman or presiding officer of the board of directors or any officer of the
corporation).
♦ The name and title of the above-signed representative.
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Department of the Secretary of State APPLICATION FOR (North Carolina Secretary of State)

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Completed 24 November 2020

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