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           State of Wisconsin                                               FILING FEE $40.00+  

           DEPARTMENT OF FINANCIAL INSTITUTIONS                    Please check box to request  
           Division of Corporate & Consumer Services                Optional Expedited Service    +   $25.00 
                 
                               APPLICATION FOR CERTIFICATE OF 
FORM   24  
Mandatory                      WITHDRAWAL AND FINAL REPORT                                                      
                               FOREIGN BUSINESS CORPORATION 
                                                      Sec. 180.1520, Wis. Stats. 
                                                             
1.                                                                   , a foreign corporation 
                        (Entity Name) 
 
organized under the laws of                                        , affirms that it is not doing business in the  
                                 (Jurisdiction) 
 
the state of Wisconsin and hereby surrenders its authority to transact business therein. 
 
2.  The corporation consents to service of process as provided under s. 180.1510(3) and (4), Wis. Stats., in 
any civil, criminal, administrative, or investigatory proceeding based on a cause of action arising during 
the time it was authorized to transact business in Wisconsin.   
 
3.  The authority of the corporation’s registered agent to accept service of process on its behalf is:  
               
   revoked         not revoked 
 
4.  The mailing address of the corporation’s principal office: 
 
 Street Address                                                                  PO Box 
                                                                                  
 City                                 State/Province                Country                    Zip/Postal Code 
                                                                                                
5.  The corporation agrees to notify the Department of Financial Institutions of any future change in the 
address provided above. 
 
                                                                                  Office Use Only 
 
DFI/CORP  /24 (R02/23)                                                                                                  1 



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6. FINAL REPORT

Using the table below, compute the highest proportion of the corporation’s capital that is or was 
represented in Wisconsin (by property located and business transacted in this state) since the date the 
corporation filed its most recent annual report with the Wisconsin Department of Financial Institutions.  If 
no annual report has been filed, calculate the highest proportion since the date of the corporation’s 
application for a certificate of authority to transact business in this state. 

A. Proportion of capital within Wisconsin
(1) Gross business in all jurisdictions:            $_____________ 
(2) Total property in all jurisdictions:            $_____________ 
(3) Total of lines A(1) and A(2):                                              $_____________ 
(4) Gross business in Wisconsin:                    $_____________ 
(5) Total property in Wisconsin:                    $_____________ 
(6) Total of lines A(4) and A(5):                                              $_____________ 
(7) Divide line A(6) by line A(3) and enter
    the result as a percentage:                                                  ___________% 

B. Value of shares issued with PAR VALUE
Complete this section if the corporation has issued shares with par value.
(1) Total value of issued shares of par-value stock,
    computed at par:                                $_____________ 
(2) Paid-in capital in excess of par, applicable
      to issued shares of par value stock:          $_____________ 
(3) Total of lines B(1) and B(2):                                              $_____________ 

C. Value of shares issued with NO PAR VALUE
(1) Total property in all jurisdictions:
    This is the same number as line A(2) above      $_____________ 
(2) Total liabilities, other than capital stock
    without par value:                              $_____________ 
(3) Subtract line C(2) from line C(1), and
    enter the result:                               $_____________ 
(4) Subtract line B(3) from line C(3), and
    enter the result:                               $_____________ 
(5) Multiply the total number of shares issued
    without par value by 10, and enter the result:  $_____________ 
(6) Enter the GREATER of line C(4) or line C(5):                               $_____________ 

D. Capital representation in Wisconsin
(1) Total of lines B(3) and C(6):                   $_____________ 
(2) Multiply line D(1) by the percentage
    entered on line A(7):                                                      $_____________ 

DFI/CORP/24 (R02/23)                                                                                    2 



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7. COMPUTATION OF FILING FEE

A. The corporation’s highest capital representation in Wisconsin
         for the period of the final report (from item 6, line D(2) above): $ ______________ 

B. Enter the amount of capital representation on which a fee has been
         previously paid to the Department.
         This figure is shown on the entity’s corporate records 
         page, which is accessible via the Department’s website, 
         in the field labeled “Paid Capital Represented.” 
                                                                            $ ______________ 

C. Subtract line B from line A and enter the result.                                                         $ ______________ 

D. If the sum on line C is positive, compute a fee of $3 for each $1,000
         (or any part thereof) of that sum and enter the result.  If the sum
          entered in line C is negative, enter zero.                                                         $ ______________ 

E.    ADD the base filing fee of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $             40.00      

F. The sum of lines D and E is the FILING FEE                               ►                                $ ______________

8. EXECUTION

         Signature                                                                                             Date 

           Printed Name                                                          Officer Title 

(Optional) This document has a delayed effective date/time of: ________________________________ 
                                                                 (up to 90 days after received date) 

Contact Information: 

                                                     Name 

                                             Mailing Address 

              City                                   State                  Zip Code 

                     Email Address                                       Phone Number 

DFI/CORP/24 (R02/23)                                                                                                          3 



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INSTRUCTIONS (Refer to section 180.1520, Wis. Stats., for document content) 

Please use BLACK ink. Submit one original to State of WI-Dept. of Financial Institutions, Box 93348, Milwaukee 
WI, 53293-0348, together with a check for the filing fee computed in item 7 above, payable to the Department of 
Financial Institutions. (If sent by express or priority U.S. mail, please mail to State of WI-Dept. of Financial 
Institutions, Division of Corporate and Consumer Services, 4822 Madison Yards Way, 4th Fl., North Tower, 
Madison WI, 53705.) If requesting optional expedited service, please check the expedited service box in the upper-
right corner of the first page and include an additional $25.00. Filing fees are non-refundable. This document can be 
made available in alternate formats upon request to qualifying individuals with disabilities. Upon filing, the 
information in this document becomes public and might be used for purposes other than those for which it was 
originally furnished. If you have any questions, please contact the Division of Corporate & Consumer Services at 
608-261-7577 (hearing-impaired may call 711 for TTY) or by email at  DFICorporations@dfi.wisconsin.gov.

Item 1.  Provide the name of the foreign corporation and the name of the jurisdiction (either a state other than 
Wisconsin or a foreign country) under whose laws it is incorporated. 

Item 2.  Section 180.1520(2)(c), Wis. Stats, requires a withdrawing foreign corporation to consent to service of 
process in any civil, criminal, administrative, or investigative proceeding based on a cause of action arising during 
the time the company was registered to do business in Wisconsin.  The manner of authorized service is set forth in 
s. 180.1510(4), Wis. Stats.

Item 3.  Specify whether the corporation revokes the authority of its registered agent in Wisconsin to accept service 
on its behalf.  If the authority of the registered agent is revoked, service of process may be made upon the 
corporation as provided in s. 180.1510(4). 

Item 4.  Provide the mailing address of the corporation’s principal office.  

Item 5.  Section 180.1520(2)(e), Wis. Stats., requires a withdrawing corporation to commit to notifying the 
Department of any change to the address provided in item 4. 

Item 6.  
      A. Proportion of capital in Wisconsin.  Use this table to calculate the highest proportion (as a
         percentage) of the corporation’s capital that has been represented in Wisconsin during the current year.
         First, calculate the corporation’s current-year gross business and property across all jurisdictions in
         lines A(1) and A(2), then add those numbers together in line A(3).  This provides the denominator for
         computing the proportion of the corporation’s business in Wisconsin.

         Next, in lines A(4) and A(5), determine the numerator by calculating the corporation’s business and
         property held in Wisconsin in the current year.  For line A(5), enter the highest amount of property held
         in Wisconsin in the current year.   Add lines A(4) and A(5) together in line A(6).

         Finally, divide the total Wisconsin business and property reflected in line A(6) by the corporation’s
         overall business and property reflected in line A(3), and enter the resulting number as a percentage in
         line A(7).  That number should represent the highest proportion of the corporation’s capital that was or
         is represented in Wisconsin since the corporation’s last annual report.

      B. Amount of paid-in capital.  This section only needs to be completed if the corporation has issued
         shares with par value.  If that is the case, determine the total value of the par-value shares issued by
         adding their combined values at par, and enter that total in line B(1).  Example: if the corporation has
         issued 100 par-value shares at $25 par value per share, it would enter $2,500 in line B(1).  Specify any
         additional paid-in capital in excess of par in line B(2), and enter the total of lines B(1) and B(2) in line
         B(3).

DFI/CORP/24 (R02/23)                                                                                                 4 



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      C. Value of shares issued without par value   . This section provides a value for shares issued without par
         value.  First, determine the corporation’s net property in line C(3) by entering its total liabilities in line
         C(2) and subtracting them from its total property entered in line C(1).  The number in line C(1) should
         match the number entered for line A(2).  Next, subtract any paid-in capital calculated in the preceding
         section by subtracting line B(3) from line C(3), and enter the total in line C(4).  This provides a
         presumptive total value of all shares issued without par value.

         The number is “presumptive” because, for purposes of this calculation, sections 180.1520(2)(f) and 
         180.1622(1)(h) of the Wisconsin Statutes establish a $10 per-share floor on the value of shares issues 
         without par value.  To determine the total floor value of all shares issued without par value, multiply 
         the total number of shares issued without par value by $10 and enter the result in line C(5).  In line 
         C(6), copy the result from either line C(4) or C(5)—whichever is the higher of the two.   

      D. Capital representation in Wisconsin.  To calculate the corporation’s total capital, enter the total of
         lines B(3) and C(6) in line D(1).  Then, to calculate the highest amount of that capital represented in
         Wisconsin during the current year, multiply line D(1) by the percentage in line A(7).

Item 7.  In line A, enter the highest amount of the corporation’s capital represented in Wisconsin in the current year 
by copying the result from item 6, line D(2).  In line B, enter the amount of capital representation on which the 
corporation has previously paid a fee to the Department.  This number can be retrieved from the corporation’s 
online record within the Department’s corporate records database, which is publicly available and accessible 
through the Department’s website.  To find it, navigate to the corporation’s online record and locate the field 
labeled “Paid Capital Represented.”  The corresponding number should reflect the amount of capital representation 
on which the corporation has previously paid a fee to the Department, and it can be entered in line B. 

Subtract line B from line A and enter the result in line C.  If the result in line C is positive, compute a fee of $3 for 
each $1,000 (or any part thereof) of the number in line C and enter the result in line D.  To make this computation, 
divide the result in line C by 1,000, then round upward to the next whole number, then multiply by $3.  Example: if 
line C is $10,500, then line D would be $33 ($10,500 divided by 1,000 is 10.5, rounded up to the next whole number 
of 11, multiplied by $3).  If the result in line C is negative, enter zero in line D. 

Add line D to line E, which reflects the current fee for this document, and enter the result in line F.  The number in 
line F represents the total filing fee for this document. 

Item 8.  This document must be executed by an officer of the corporation, subject to two limited exceptions:  (1) if 
directors have not been selected, it may be signed by an incorporator identified in the initial articles of 
incorporation; and (2) if the corporation is in the hands of a receiver, trustee or other court-appointed fiduciary, it 
may be signed by the fiduciary.  Corporate directors are not authorized to sign this document in their capacities as 
directors.  (A corporate director who also serves as an officer may sign the document, but that person must sign in 
their capacity as an officer of the corporation.) 

Optional delayed effective date/time.  This document may declare a delayed effective date and time.  The 
effective date/time may not be before, or more than 90 days after, the document is received by the Department of 
Financial Institutions for filing.  If no effective date/time is specified, the document will take effect at the close of 
business on the date it is received for filing by the Department. 

DFI/CORP/24 (R02/23)                                                                                                      5 






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