Secretary of State Office          APPLICATION FOR 
500 E Capitol Ave 
                            CERTIFICATE OF WITHDRAWAL 
Pierre, SD 57501 
                            FOREIGN BUSINESS  ORPORATIONC                          
(605)773-4845                                       SDCL 47-1A-1520 
corpinfo@state.sd.us
                                                    FILING FEE: $10 
                                   Make check payable to SECRETARY OF STATE

1. The Name and Business ID of the corporation is:

   Name (Note: This must be the exact corporate name as registered.)                      Business ID 

2. The name of the state or other jurisdiction under whose laws it is incorporated:

3. The corporation is no longer transacting business in this state and it surrenders its authority to transact business in this
   state.

4. The corporation revokes the authority of its registered agent to accept service on its behalf.
5. The address of the corporations’principal office (this is the address of the executive offices of the company):

   Street Address                                                    City                              State ZIP+4 

   Mailing Address if different from street address                  City                              State ZIP+4 

   Email Address (Optional) 

The application must be signed by an authorized officer of the corporation. 

No person may execute this report knowing it is false in any material respect.  Any violation may be subject to a civil and/or 
criminal penalty (SDCL 47-1A-129; 22-39-36). 

Dated 
                                                                     Signature of an authorized person 

Email 
      (Optional)                                                     Printed Name 

                                                                     Title 

                                                                                          Foreignapplicationwithdrawal Feb 2018