Secretary of State 
                                                                    Business Programs Division 
                                                                               Business Entities 
                                                              1500 11th Street, Sacramento, CA 95814 
                                                     P.O. Box 944260, Sacramento, CA 94244-2600 

                              Business Entities Submission Cover Sheet

            For faste stservice, file online at               bizfileOnline.sos.ca.gov. 

Instructions: 

• Complete and include this form with your paper submission. This form will not be made part of
  the filed document.

• Make all checks or money orders payable to the Secretary of State.

• In-person submissions (excluding Statements of Information): $15    special handling fee  . Do not
  include     a $15 special handling fee when submitting documents by mail.

• All submissions are reviewed in the date order of receipt , with online submissions given priority.
  For updated processing time information, visit www.sos.ca.gov/business/be/processing-dates.

• To obtain a certified copy,  includ ecertification fees with your submission.

            Note: All correspondence related to your submission will be 
            sent to the name and address on your check or money order.

Contact Person                (Please type or print legibly): 

First Name:                                    Last Name: 

Phone Number:                                 Email:

Entity Information (Please type or print legibly): 

Entity Name:  

Entity Number (if applicable): 

Comments: 

                                                                    Clear Form Print Form
Submission Cover Sheet (REV 03/2024) 

                   Secretary of State                                         SURC
                   Certificate of Surrender 
                   (Foreign Qualified Corporation ONLY) 

There is No Fee for filing a Certificate of Surrender 

Certified Copy Fee (Optional) –   $5.00

Note: For information about Franchise Tax Board final tax 
return requirements, go to ftb.ca.gov. 
                                                                                                 This Space For Office Use Only 

                               (Enter the exact name of the corporation as it is recorded with the California Secretary of State.   Note:  If you 
1. Corporate Name              registered in California using an assumed name.) 

2. Secretary of State Entity Number                              3. Jurisdiction (State, foreign country or place where this corporation is formed.)

4. Mailing Address to mail copies of Legal Service (Enter the complete mailing address where the California Secretary of State may
     forward copies of any legal documents against the corporation that are served on the Secretary of State intended for the corporation.)
Mailing Address of Corporation                                           City (no abbreviations)            State      Zip Code 

5. Required Statements (Do not alter the Required Statements – ALL must be true to file this Certificate of Surrender.)

Statements 5(a) – 5(d) are true: 
   a) The corporation surrenders its rights and authority to transact intrastate business in the State of 
      California.
   b) The corporation revokes its designation of agent for service of process in California.
   c) The corporation consents to process against it in any action upon any liability or obligation incurred
      within the State of California prior to the filing of this Certificate of Surrender may be served upon the
      California Secretary of State.
   d) All final returns required under the California Revenue and Taxation Code have been or will be filed
      with the California Franchise Tax Board.

6. Read and Sign Below         (Office or title not required. )

I am a corporate officer and am authorized to sign on behalf of the foreign corporation. 

  __________________________________________________________                    ____________________________________________________ 
Signature                                                                        Type or Print Name

SURC (REV 03/2022)                                                                                          20 22California Secretary of State       
                                                        Clear Form       Print Form                                    bizfileOnline.sos.ca.gov