Free F-13 - Arkansas

Arkansas Secre t a ry of State
Charlie Daniels
State Capitol · Little Rock, Arkansas 72201-1094 501-682-3409 · www.sos.arkansas.gov

Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock

Certificate of Withdrawal of Foreign Corporation
The undersigned, pursuant to the Arkansas Business Corporation Act, (Act 958 of 1987), sets forth the following: 1 Corporation Name:

2. State of Incorporation: 3. The Corporation is not transacting business in this State and hereby surrenders its authority to do so. 4. The Corporation revokes the authority of its registered agent to accept service of process on its behalf and appoints the Secretary of State as its agent for service of process in any proceeding based on a cause of action arising during the time it was authorized to transact business in this State. The Secretary of State shall be notified of any change of address of this corporation. 5. The corporation mailing address for any process served under above paragraph 4 is:

Name:

Address:

City, State, & ZIP:

Phone:

Signed this

day of

,

.

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.

Authorizing Officer and Title (Type or Print)

Authorized signature and title

Fee: $300.00 payable to Arkansas Secretary of State

F-13/Rev. 4/06