Application For Certificate Of Withdrawal Foreign Profit Corp

New Mexico Secretary of State Business Services Division 325 Don Gaspar, Suite 300 267 Santa Fe, NM 87501 (800)477-3632 267 www.sos.state.nm.us American LegalNet, Inc. www.FormsWorkFlow.com SUBMIT AN ORIGINAL $50 FEE FOREIGN PROFIT CORPORATION APPLICATION FOR CERTIFICATE OF WITHDRAWAL The undersigned corporation, in order to apply for a Certificate of Withdrawal under the New Mexico Business Corporation Act, submits the following statement to the Secretary of State: 1.The name of the corporation and the Business ID # are: 2.It is incorporated under the laws of: 3.It is not transacting business in New Mexico. It surrenders its authority to transact business in new Mexico. Itrevokes the authority of its registered agent in New Mexico to accept service of process, and consents thatservice of process in any action, suit or proceeding based upon any cause of action arising in New Mexico maythereafter be made on it by service thereof on the Secretary of State of New Mexico.4.The mailing address to which any service of process can be forwarded to is (Cannot be a PO Box): 5.The aggregate number of shares which it has authority to issue as of the date of this application, itemized byclass and series, if any, within each class is: New Mexico Secretary of State Business Services Division 325 Don Gaspar, Suite 300 267 Santa Fe, NM 87501 (800)477-3632 267 www.sos.state.nm.us American LegalNet, Inc. www.FormsWorkFlow.com 6.The aggregate number of shares that have been issues as of the date of this application, itemized by class andseries, if any, within each class is: Dated: The application must be submitted with the following approved clearances: 1.Letter of Clearance (Secretary of State)2.Certificate of Compliance (Department of Workforce Solutions)3.Certificate of No Tax Due (Taxation and Revenue Department) American LegalNet, Inc. www.FormsWorkFlow.com SOS TC 10/13 Date: The exact name of the entity as registered with our office is: Taxation and Revenue ID SUBJECT: Tax Clearance Request for Dissolution/Withdrawal This entity is in the process of dissolving/withdrawing from the State of New Mexico and is requesting tax clearance. FINAL DAY OF BUSINESS: Month Day Year NOTE: The entity cannot be issued a Tax Clearance for a future date or if it is delinquent in filing reports and/or paying fees due. A final report may be required through the final day of business, you will be advised accordingly. Signature of Officer or Authorized Agent NAME: ADDRESS: CITY: ST: ZIP CODE: TELEPHONE: EMAIL ADDRESS: MAIL TO: Secretary of State-Tax Compliance Section 325 Don Gaspar, Suite 300, Santa Fe NM 87501 Secretary of State Business Services Division 325 Don Gaspar, Suite 300 267 Santa Fe, NM 87501 (800)477-3632 267 www.sos.state.nm.us New Mexico American LegalNet, Inc. www.FormsWorkFlow.com DOCUMENT DELIVERY INSTRUCTION FORM (You must have one Document Delivery Instruction Form for each filing being submitted) Entity Name: Mailing Address (Include city, state and zip code): Contact Name: Contact Phone Number: Contact Email: IF YOU HAVE SELECTED TO PICK UP YOUR DOCUMENTS, OUR OFFICE WILL CONTACT YOU WHEN YOUR DOCUMENTS ARE COMPLETED AND READY FOR PICK UP. DOCUMENTS WILL NOT BE HELD FOR MORE THAN 5 BUSINESS DAYS. IF YOU HAVE NOT PICKED THEM UP WITHIN THAT TIME FRAME, THEY WILL BE MAILED TO THE ADDRESS LISTED ABOVE. PLEASE CONTACT OUR OFFICE AT 800-477-3632 AND NOTIFY US IF YOU ARE NOT ABLE TO PICK THEM UP WITHIN THAT TIME FRAME. ---THANK YOU New Mexico Secretary of State Business Services Division 325 Don Gaspar, Suite 300 267 Santa Fe, NM 87501 (800)477-3632 267 www.sos.state.nm.us Please check how the documents are to be delivered Will Pick Up Mail to Address Above American LegalNet, Inc. www.FormsWorkFlow.com