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Application For Withdrawal Of Certificate Of Authority CD 555 - Georgia

Application For Withdrawal Of Certificate Of Authority Form. This is a Georgia form and can be used in Corporation Secretary Of State .
 Fillable pdf Last Modified 6/10/2015
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OFFICE OF SECRETARY OF STATE CORPORATIONS DIVISION 2 Martin Luther King Jr. Dr. SE Suite 313 West Tower Atlanta, Georgia 30334 (404) 656-2817 Brian P. Kemp Secretary of State APPLICATION FOR WITHDRAWAL OF CERTIFICATE OF AUTHORITY 1. Entity Type (check one only): Corporation Limited Liability Company Limited Partnership/Limited Liability Limited Partnership Limited Liability Partnership Entity Control Number: _________________________ 2. Entity Name: _______________________________________________________________________________ 3. Home State/Country (State/Country in which entity was formed): ______________________________________ 4. The entity selected in item 1 and named in item 2 no longer transacts business in Georgia and surrenders its certificate of authority. 5. The entity revokes the authority of its registered agent to accept service of process on its behalf and appoints the Secretary of State of Georgia as its agent for service in any proceeding based on a cause of action that arose during the time it was authorized to transact business in Georgia. 6. Any process served on the entity after withdrawal from Georgia may be mailed to the following address: 7. The withdrawing entity commits that it will notify the Secretary of State of any changes in the mailing address provided in item 6. 8. _______________________________________________________ Signature _______________________________________________________ Print Name Signer's Capacity (check one only): Corporation: LLC: LP/LLLP: LLP: Officer Receiver or Trustee Attorney-in-fact Member Manager Receiver or Trustee Attorney-in-fact Authorized Person Authorized Person ________________________ Date Please mail completed application to the address provided at the top of this form. Certificate of withdrawal will be emailed to the email address provided below. Email Address: _______________________________________________________________ Form CD 555 (Rev. 4/2015) American LegalNet, Inc.
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