nonprofitforeignapplicationwithdrawal Feb 2018
Secretary of State Office
500 E Capitol Ave
Pierre, SD 57501
(605)773-4845
corpinfo@state.sd.us
1. The Name and
Business ID of the corporation is:
Name (Note: This must be the exact corporate name as registered.) Business ID
2. The name of the state or other jurisdiction under whose laws it is incorporated:
3. The corporation is no longer doing or engaging in any business in this state and it surrenders its authority to transact
business in South Dakota.
4. The cor
poration revokes the authority of its registered agent in your State to accept service of process, and consents
that service of process in any action, suit or proceeding based upon any cause of action arising in your State during the
time the corporation was authorized to transact business in your State may thereafter be made on the corporation by
service thereof on the Secretary of State of your State.
5. The post-office address to which the Secretary of State may mail a copy of any process against the corporation that
may be served is:
Street Address
City State
ZIP+4
Mailing Address if different from street address
City State
ZIP+4
Email Address (Optional)
The appli
cation must be signed by an authorized officer of the corporation.
No person may execute this report knowing it is false in any material respect. Any violation may be subject to a civil and/or
criminal penalty (SDCL 22-39-36).
Dated
Signature of an authorized person
Email
(Optional) Printed Name
Title
APPLICATION FOR
CERTIFICATE OF WITHDRAWAL
FOREIGN NONPROFIT CORPORATION
FILING FEE: $5
Make check payable to SECRETARY OF STATE
click to sign
signature
click to edit
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