State of Wisconsin                                                                        FILING FEE $40.00  
          DEPARTMENT OF FINANCIAL INSTITUTIONS                                                     Please check box to request 
                                                                                                                                      +   $25.00 
          Division of Corporate & Consumer Services                                                  Optional Expedited Service 
                 
FORM   524                          WITHDRAWAL OF REGISTRATION OF 
Mandatory                          FOREIGN LIMITED LIABILITY COMPANY                                                                    
                                                     Sec. 183.0911, Wis. Stats. 

1.                                                                                                , a foreign limited liability company 
                        (Entity Name) 
 
organized under the laws of                                       , affirms that it is not doing business in the  
                                      (Jurisdiction) 
                   
state of Wisconsin and hereby withdraws its registration to do business therein. 
 
2.  The foreign limited liability company consents to service of process as provided under s. 183.0911, 
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 foreign limited liability company’s registered agent to accept service of process on 
                               
its behalf is:     revoked           not revoked 
 
4.  The mailing address of the foreign limited liability company’s principal office: 
 
 Street Address                                                                                     PO Box 
                                                                                                     
 City                                 State/Province               Country                                          Zip/Postal Code 
                                                                                                                     
5.  The foreign limited liability company agrees to notify the Department of Financial Institutions of any 
future change in the address provided above. 
 
6.  This document must be signed by a person authorized by the company: 
 
                 Signature                                                                                     Date 
 
                   Printed Name                                                                               Title 
                                    
(Optional) This document has a delayed effective date/time of: ________________________________ 
                                                                                                  (up to 90 days after received date) 
 
                                                                                                     Office Use Only 
 
DFI/CORP  /524 (R01/23)                                                                                                                      1 

Contact Information: 
       
                                              Name 

                                            Mailing Address 

                   City                       State                           Zip Code 

                     Email Address                                        Phone Number 

INSTRUCTIONS (Refer to section 183.0911, 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 $40.00 filing fee, 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 limited liability company and the name of the jurisdiction (either a state 
other than Wisconsin or a foreign country) under whose laws the foreign limited liability company is organized. 
 
Item 2.  Section 183.0911(1)(c), Wis. Stats, requires a withdrawing foreign limited liability company 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. 183.0119, Wis. Stats. 
 
Item 3.  Specify whether the foreign limited liability company 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 foreign limited liability company as provided in ss. 183.0119 (2), (3), or (5), as applicable. 
 
Item 4.  Provide the mailing address of the foreign limited liability company’s principal office.  If the foreign 
limited liability company has no principal office, enter an alternative address to which service of process may be 
made. 
 
Item 5.  Section 183.0911(1)(d), Wis. Stats., requires a withdrawing foreign limited liability company to commit to 
notifying the Department of any change to the address provided in item 4. 
 
Item 6.  The document must be executed by one or more persons authorized by the company. 
 
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/524 (R01/23)                                                                                                     2