North Carolina > Secretary Of State > Business Entity
Application For Certificate Of Withdrawal By Reason Of Merger Consolidation Or Conversion BE-09 - North Carolina
| Application For Certificate Of Withdrawal By Reason Of Merger Consolidation Or Conversion Form. This is a North Carolina form and can be used in Business Entity Secretary Of State . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
State of North Carolina Department of the Secretary of State APPLICATION FOR CERTIFICATE OF WITHDRAWAL BY REASON OF MERGER, CONSOLIDATION OR CONVERSION Pursuant to 55-15-21, 55A-15-21, 57C-7-12, 59-91 or 59-909, of the General Statutes of North Carolina as applicablee , th undersigned entity, as the surviving or resulting entity in a statutory merger, consolidation or conversion hereby applies to the Secretary of State for a Certificate of Withdrawal for the foreign entity(ies) authorized to transact business or conduct affairs in the State of North Carolina named below, whose separate existence has ceased as a result of the merger, consolidation or conversion, and for that purpose submits the following statement: 1. The name of the surviving or resulting entity is:_______________________________________________________________ a. The surviving or resulting entity is incorporated, formed or created under the laws of: __________________________________________________________________________________________________ b. The type of entity of the surviving or resulting entity:________________________________________________________ ___________________________________________________________________________________________________ 2. The surviving or resulting entity is not authorized to transact business or conduct affairs in the State of North Carolina. 3. The name of each foreign entity authorized to transact business in North Carolina (and its fictitious name used in the State of North Carolina, if differentfrom its official name) is:_____________________________________________________________ ________________________________________________________________________________________________________ a. The name of the state or country under whose law each such entity was incorporated, formed or created is:__________________________________________________________________________________________________ ____________________________________________________________________________________________________ b. The type of entity of each foreign entity:____________________________________________________________________ ____________________________________________________________________________________________________ 4. The surviving or resulting entity hereby consents that service of process based on any cause of action arising in thof Norte State h Carolina, or arising out of business transacted or affairs conducted in this State during the time each foreign entity was authorized to transact business or conduct affairs in this State may thereafter be made by service thereof on the Secretary of State. 5. The mailing address to which the Secretary of State may macopyil a of any process served pursuant to the paragraph above i: s C/O_____________________________________________________________________________________________________ Address_________________________________________________________________________________________________ City, State, Zip Code_______________________________________________________________________________________ 6. The surviving or resulting entity hereby agrees to file a statement of any subsequent change in its mailing address with the Secretary of State. 7. Attached hereto is a copy of the articles of merger, consolidation or conversion or a certificate reciting the facts of the merger, consolidation or conversion duly authenticated by the Secretary St ofate or other official having custody of records of such entities in the state or country under the laws of which such merger was effected. CORPORATIONS DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622 (Revised January 2002) (Form BE-09) <<<<<<<<<********>>>>>>>>>>>>> 28. This application will be effective upon filing, unless a date and/or time is specified here:____________ This the ________day of ________________ , 20____ ____________________________________ Name of Surviving/Resulting Entity ____________________________________ S ignature ____________________________________ Type or Print Name and Title NOTES 1. Filing fee is $10. This application must be filed with the Secretary of State. The application must be accompanied by a copy of the articles of merger, consolidation or conversion or a certificate reciting the facts of the merger, consolidation or conversionduly authenticated by the Secretary of State or other official having custody of the records of such entities in the state or couny utr nder the laws of which the foreign entity was organized, incorporated or created. 2. This form is to be used only if the surviving corporation is not authorized to transact business or conduct affairs in North Carolina. CORPORATIONS DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622 (Revised January 2002) (Form BE-09)
|
|||||||
