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                                        District of Columbia Government 
                                                Corporations Division 
                            Withdrawal of Foreign Registration Statement Form FN-3 
                                                   Ver. 3, October 2022 
 Use this form to withdraw foreign filing entity from the District of Columbia. This withdrawal has no effect on an entity’s licensing and/or tax 
 obligations. It is the organization’s responsibility to ensure compliance in those areas. 
                      ENTITY TYPE / AUTHORITY                                                  FILING FEE 
               Foreign Filing Entity: § 29–105.07.              Refer to Corporate Fee Schedule posted online; 

 Under the provisions of the Title 29 of D.C. Code (Business Organizations Act), the foreign filing entity listed below 
 hereby applies for a Certificate of Withdrawal and for that purpose submits the statement below. 
 1. Entity Name

 2. Date of Issuance of Certificate of Foreign Registration

 3. Name of State/Province/Country of Formation

 4. The entity is not doing business in the District and that it withdraws its registration to do business in the District.

 4A. The entity revokes the authority of its registered agent to accept service on its behalf. 

 4B. Address for the service of process (Address that legal complaints can be forwarded to) 

     If you sign this form you agree that anyone who makes a false statement can be punished by criminal penalties of a fine up 
                   to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405; 
     5. Name of the Governor or Authorized Person          5A. Signature of the Governor or Authorized Person 

Mail all forms and required payment to:                    Many corporate filings are available online. 
Department of Licensing and Consumer Protection 
Corporations Division                                      Go to our CorpOnline site at https://corponline.dlcp.dc.gov  and sign in 
PO Box 92300                                               with Access DC to proceed.  
Washington, DC 20090  
                                                           Online filings are paid by credit card. 
Phone: (202) 442-4432