APPLICATION FOR CERTIFICATE OF WITHDRAWAL FOR ALIEN BUSINESS ORGANIZATION
(Name of Alien Business Organization)
(Incorporated or Organized Under Laws of)
This entity is no longer required to maintain a registered agent in this state.
(Signature of Officer or Director)
(Typed or Printed Name)
(Capacity of Person Signing Application)
Filing Fee: $35.00 Certified Copy (Optional): $52.50
INHS069(10/03)