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                      District of Columbia Government 
                                              Corporations Division

               Withdrawal of Foreign Registration Statement Form FN-3, Ver. 2, April 2018.                   
Use this form to withdraw foreign filing entity from the District of Columbia. This withdrawal has no effect on entity’s licensing 
and/or tax obligations so It is 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:                    Corporate Online Services Information: 
Department of Consumer and Regulatory Affairs              Many corporate filings are available by using CorpOnline 
Corporations Division                                      Service. 
PO Box 92300                                               Go to CorpOnline site at https://corponline.dcra.dc.gov, create 
Washington, DC 20090                                       the profile, access the online services main page and proceed. 
                                                           Online filers must pay by using the credit card. 
Phone: (202) 442-4432