Application For Certificate Of Withdrawal For Profit Foreign Corporation {44}

Filing Fee: $35.00 Use black print or type. Leave 1" margins both sides. Form 44 RSA 293-A:15.20 APPLICATION FOR CERTIFICATE OF WITHDRAWAL OF A FOR-PROFIT FOREIGN CORPORATION PURSUANT TO THE PROVISIONS of the New Hampshire Business Corporation Act, the undersigned corporation hereby applies for a certificate of withdrawal from New Hampshire, and for that purpose submits the following statement: FIRST: The name of the corporation is . SECOND: It is incorporated under the laws of . THIRD: It is not transacting business in New Hampshire. FOURTH: It hereby surrenders its authority to transact business in New Hampshire. FIFTH: It revokes the authority of its registered agent in New Hampshire to accept service 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. SIXTH: The mailing address to which the Secretary of State may mail a copy of any process against the corporation that may be served on him is . SEVENTH: The corporation will notify the Secretary of State in the future of any change in its mailing address. EIGHTH: The corporation is in good standing as evidenced by the filing of all annual report(s) due. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Form 44 Page 1 APPLICATION FOR CERTIFICATE OF WITHDRAWAL Form 44 (cont.) NINTH: A statement is attached from the New Hampshire Department of Revenue Administration that all taxes due from or accrued by the corporation through the date of the application for withdrawal have been either assessed and paid, or adequately provided for in a manner acceptable to the New Hampshire Department of Revenue Administration. (Note 1) (Corporate name) (Note 2) (Signature) (Print or type name) (Note 2) (Title) Date signed: Notes: 1. Exact corporate name of corporation making statement. 2. Signature and title of person signing for the corporation. Must be signed by chairman of the board of directors, president or another officer; or see RSA 293-A:1.20(f) for alternative signatures. SECRETARY OF STATE'S WITHDRAWAL FILING REQUIREMENTS: 1. Obtain original tax certificate from the N.H. Dept. of Revenue Administration. To obtain this tax certificate, Certificate Request Form AU-22 must be completed and submitted to the N.H. Dept. of Revenue Administration. Follow this link to obtain the required form: http://www.nh.gov/revenue/business/certificates.htm 2. Mail completed Form 44 with original tax certificate from the Dept. of Revenue Administration and $35.00 filing fee rd to: (Physical location: 25 Capitol Street, 3 Floor, Concord, NH 03301) Corporation Division Department of State 107 North Main Street Concord, NH 03301-4989. DISCLAIMER: All documents filed with the Corporation Division become public records and will be available for public inspection in either tangible or electronic form. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Form 44 Page 2 (5/2008)