State of New Hampshire 

                     APPLICATION FOR CERTIFICATE OF WITHDRAWAL 
                        OF A FOR-PROFIT FOREIGN CORPORATION 

                 INSTRUCTIONS FOR FILING FORM 44 (RSA 293-A:15.20) 

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.revenue.nh.gov/forms/2017/documents/au-22-2016.pdf 

2. Mail completed Form 44 with original tax certificate from the Dept. of Revenue Administration and $35.00 filing
   fee to:
   Corporation Division 
   Dept of State 
   107 N Main St 
   Concord  NH  03301-4989 
   OR, deliver the paperwork in person to: 
   State House Annex, 3rd Floor, Room 317 
   25 Capitol Street 
   Concord, NH 

Mailing Address - Corporation Division, NH Dept. of State, 107 N Main St, Rm 204, Concord, NH 03301-4989 
          Physical Location - State House Annex, 3rd Floor, Rm 317, 25 Capitol St, Concord, NH 
                                                                                    Form 44  (Instruct.) 

Print    Reset
                         State of New Hampshire 
 
Filing Fee: $35.00                                                                                      Form 44 
Use black print or type.                                                                        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. 
 
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. 
 
                                                                                   (Corporate name) 
 
                                                                                   (*Signature) 
 
                                                                                   (Print or type name) 
 
                                                                                   (*Title) 
 
                                                           Date signed:                                              

* 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. 
 
DISCLAIMER:  All documents filed with the Corporation Division become public records and will be available for 
public inspection in either tangible or electronic form. 
 
  Mailing Address - Corporation Division, NH Dept. of State, 107 N Main St, Rm 204, Concord, NH 03301-4989 
         Physical Location - State House Annex, 3rd Floor, Rm 317, 25 Capitol St, Concord, NH 
 
                                                                                                        Form 44  (9/2015)