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Sec. 181.1520 Wis. Stats.

State of Wisconsin DEPARTMENT OF FINANCIAL INSTITUTIONS Division of Corporate & Consumer Services

FOREIGN NONSTOCK CORPORATION ­ WITHDRAWAL APPLICATION
1. (Corporation Name) organized under the laws of and holding a certificate of authority to (State/Country) transact business in Wisconsin, hereby surrenders that authority, applies for a Certificate of Withdrawal, and states: 2. The corporation is not transacting business in Wisconsin. 3. The authority of its registered agent to accept service of process on its behalf is hereby revoked. 4. The corporation hereby consents to service of process under sec. 181.1510(3) and (4) in any civil, criminal, administrative or investigatory proceeding based on a cause of action arising during the time it was authority to transact business in Wisconsin. 5. The mailing address of the corporation's principal office, if different from that shown on its most recent annual report, is: , a foreign nonstock corporation

6. The corporation agrees to notify the Department of Financial Institutions of any future change in the mailing address of its principal office. 7. Executed on (Date) Title: ! President or other officer title (Signature)

! Secretary
(Printed name)

This document was drafted by (Name the individual who drafted the document)

FILING FEE - $30.00

See instructions, suggestions and procedures on following page. 1 of 2

DFI/CORP/124(R02/10/03) Use of this form is mandatory.

FOREIGN NONSTOCK CORPORATION WITHDRAWAL APPLICATION


Your return address and phone number during the day: (

) ______ -

____________

INSTRUCTIONS (Ref. sec. 181.1520, Wis. Stats. for document content) Submit one original and one exact copy to Department of Financial Institutions, P O Box 7846, Madison WI, 53707-7846, together with the filing fee of $30.00. Filing fee is non-refundable. (If sent by Express or Priority U.S. mail, address to 345 W. Washington Ave., 3rd Floor, Madison WI, 53703). The original must include an original manual signature, per sec. 181.0120(2), Wis. Stats. NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made with the department. Information requested may be used for secondary purposes. If you have any questions, please contact the Division of Corporate & Consumer Services at 608-261-7577. Hearingimpaired may call 608-266-8818 for TDY. This application is appropriate for use by a foreign non-stock corporation, including a non-profit corporation. Foreign business corporations apply on Form 24. 1. Enter the name of the corporation and the state in which it is incorporated. If the corporation is licensed in this state under a fictitious name, provide the fictitious name as well. 2, 3 & 4. These statements under sec. 181.1520. 5. Provide the mailing address of the corporation's principal office, if different from that shown on its most recent annual report. 6. Sec. 181.1520 requires a commitment by the corporation to notify the department in the future of any change in the mailing address of its principal office. 7. The application is to be executed by an officer of the corporation. Print or type the name and title of the officer signing the application and the date it was signed.

DFI/CORP/124(R02/10/03) Use of this form is mandatory.

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