REV 31 0037 (6/21/19)
Revenue Clearance Certificate Application
(Withdrawal or Dissolution of a Corporation and Guaranty)
All Fields Must Be Completed
FEIN Number
1. Name of Account ID/
Corporation UBI Number:
____________________________________________________ ___________________ _________ _______________
Street Address City State Zip
2. What is the address of the business in Washington?
3. What did the company do in Washington?
4. Last date corporation had business activity in Washington State:
5. What is the reason for ceasing business activity in Washington State?
6. Have all tax returns been filed and paid through the date entered on Question 4 above? Yes No
If all excise tax returns have not been filed and paid, the application cannot be processed.
7. If the business is to be continued by someone else (successor), please provide the following information.
Name of Account ID/
Successor UBI Number
____________________________________________________ ___________________ _________
Street Address City State Zip
8. Name and phone number of the person to contact if there are questions regarding this application.
Name Phone Email/DOR User ID
9. Where would you like the Department of Revenue Clearance Certificate sent?
To “My DORPlease provide User ID:
Regular Email:
o By checking this box, I authorize the Department to send my confidential tax information using
regular email (refer to page two for more information).
o Email Address:
Application cannot be processed if not signed and dated.
I certify that the above information is true and correct. In consideration of the issuance in accordance
with RCW 82.32.260, by the Department of Revenue of its certificate certifying that every license fee,
tax increase or penalty imposed has been paid or provided for by said corporation, the undersigned
hereby agrees to pay to Department of Revenue, upon its demand, any and all such fee, tax increase
or penalty as may hereafter be determined to be unpaid and payable by this corporation.
Corporate Officer Signature Date
Print Name Title
Washington State
Department of Revenue
Audit Division
PO Box 47474
Olympia, WA 98504
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REV 31 0037 (6/21/19)
Purpose: This form is to obtain a Revenue Clearance Certificate needed to dissolve a corporation with the
Secretary of State.
If your business is a Washington State LLC, PLLC, LP or an LLP, this application is not necessary. If your
business is a foreign LLC, LP or an LLP, this application will be necessary. If your company is not registered
with the Secretary of State, a Revenue Clearance Certificate is not required.
Question #1Name of Corporation and Account ID (UBI No.) should be listed as it is registered with the
Secretary of State’s Office
Question #2Please provide the physical address of the business location in Washington. If there are
multiple locations, please provide the primary address.
Question #3 Describe the Washington business activities engaged in.
Questions #4, #5 and #6Give the actual date and reason the company ceased business activities in
Washington. Be sure to have all excise tax returns filed and paid through the closing date. If closing mid-
year, etc., an excise tax return is still needed even if there was no activity. Please visit for
additional information.
Question #7Per RCW 82.04.180, "Successor" means:
a) Any person to whom a taxpayer quitting, selling out, exchanging, or disposing of a business
sells or otherwise conveys, directly or indirectly, in bulk and not in the ordinary course of the
taxpayer's business, more than fifty percent of the fair market value of either the (i) tangible
assets or (ii) intangible assets of the taxpayer; or
b) A surviving corporation of a statutory merger.
c) Any person obligated to fulfill the terms of a contract shall be deemed a successor to any
contractor defaulting in the performance of any contract as to which such person is a surety
or guarantor.
Question #8 This information can be used to contact you about questions pertaining to your application
and/or business activities.
Tax information is confidential and cannot be shared with anyone without the taxpayer’s express permission.
Therefore, a Confidential Tax Information Authorization form will be necessary if you wish to authorize the Dept
of Revenue to share your tax information with any third party person(s) listed in Question #8.
DOR Logon ID (defined) This is the Logon ID to access My Account on the Department of Revenue’s
website. Once in My Account, you can communicate with the Department through Secure Messaging.
Question #9Please provide a DOR My Account Logon ID or Email Address to receive your certificate.
Additional information about providing your email address: I am aware of the Department’s secure
message system available in My Account. I know regular email is not secure, and confidential
information may be intercepted by unauthorized persons. I accept these conditions and waive any
violation of the Secrecy Clause resulting from use of unsecured email. (RCW 82.32.330)
The application must be signed by a corporate officer or a stockholder of the company listed in Question
The Revenue Clearance Certificate and other required documents must be sent to the Secretary of
State’s Office to dissolve your corporation.
If you have any questions about completing this application, please call Corporate Dissolutions at 360-704-5704. Visit our
website (, or email us at Email all applications to
To ask about the availability of this form in an alternate format for the visually impaired, please call 360-705-6705.
Teletype (TTY) users may use the Washington Relay Service by calling 711.