Form 564 "Certificate of Surrender Foreign Licensed Corporation (For-Profit or Nonprofit Foreign Corporation)" - Ohio

What Is Form 564?

This is a legal form that was released by the Ohio Secretary of State - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Ohio Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 564 by clicking the link below or browse more documents and templates provided by the Ohio Secretary of State.

ADVERTISEMENT
ADVERTISEMENT

Download Form 564 "Certificate of Surrender Foreign Licensed Corporation (For-Profit or Nonprofit Foreign Corporation)" - Ohio

Download PDF

Fill PDF online

Rate (4.3 / 5) 19 votes
Toll Free: 877.767.3453 | Central Ohio: 614.466.3910
OhioSoS.gov
|
business@OhioSoS.gov
File online or for more information:
OhioBusinessCentral.gov
Filing Form Cover Letter
Please return the approval certificate to:
Name
(Individual or Business Name):
To the Attention of
(if necessary):
Address:
City:
State
ZIP Code:
Phone Number:
E-mail Address:
Check here if you would like to receive important notices via email from the Ohio Secretary of State's office regarding
Business Services.
Check here if you would like to be signed up for our Filing Notification System for the business entity being created or
updated by filing this form. This is a free service provided to notify you via email when any document is filed on your
business record.
Please make checks or money orders payable to: "Ohio Secretary of State"
Type of Service Being Requested: (PLEASE CHECK ONE BOX BELOW)
Regular Service: Only the filing fee listed on page one of the form is required and the filing will be
processed in approximately 3-7 business days. The processing time may vary based on the volume of
filings received by our office.
Expedite Service 1: By including an Expedite fee of $100.00, in addition to the regular filing fee on page
one of the form, the filing will be processed within 2 business days after it is received by our office.
Expedite Service 2: By including an Expedite fee of $200.00, in addition to the regular filing fee on page
one of the form, the filing will be processed within 1 business day after it is received by our office.
This
service is only available to walk-in customers who hand deliver the document to the Client Service Center.
Expedite Service 3: By including an Expedite fee of $300.00, in addition to the regular filing fee on page
one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00
p.m.
This service is only available to walk-in customers who hand deliver the document to the Client Service Center.
Preclearance Filing: A filing form, to be submitted at a later date for processing, may be submitted to be
examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The
Preclearance will be complete within 1-2 business days.
Last Revised: 11/2019
Form 564
Page 1 of 6
Toll Free: 877.767.3453 | Central Ohio: 614.466.3910
OhioSoS.gov
|
business@OhioSoS.gov
File online or for more information:
OhioBusinessCentral.gov
Filing Form Cover Letter
Please return the approval certificate to:
Name
(Individual or Business Name):
To the Attention of
(if necessary):
Address:
City:
State
ZIP Code:
Phone Number:
E-mail Address:
Check here if you would like to receive important notices via email from the Ohio Secretary of State's office regarding
Business Services.
Check here if you would like to be signed up for our Filing Notification System for the business entity being created or
updated by filing this form. This is a free service provided to notify you via email when any document is filed on your
business record.
Please make checks or money orders payable to: "Ohio Secretary of State"
Type of Service Being Requested: (PLEASE CHECK ONE BOX BELOW)
Regular Service: Only the filing fee listed on page one of the form is required and the filing will be
processed in approximately 3-7 business days. The processing time may vary based on the volume of
filings received by our office.
Expedite Service 1: By including an Expedite fee of $100.00, in addition to the regular filing fee on page
one of the form, the filing will be processed within 2 business days after it is received by our office.
Expedite Service 2: By including an Expedite fee of $200.00, in addition to the regular filing fee on page
one of the form, the filing will be processed within 1 business day after it is received by our office.
This
service is only available to walk-in customers who hand deliver the document to the Client Service Center.
Expedite Service 3: By including an Expedite fee of $300.00, in addition to the regular filing fee on page
one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00
p.m.
This service is only available to walk-in customers who hand deliver the document to the Client Service Center.
Preclearance Filing: A filing form, to be submitted at a later date for processing, may be submitted to be
examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The
Preclearance will be complete within 1-2 business days.
Last Revised: 11/2019
Form 564
Page 1 of 6
Form 564 Prescribed by:
Mail this form to one of the following:
Toll Free: 877.767.3453
Regular Filing (non expedite)
Central Ohio: 614.466.3910
P.O. Box 1329
Columbus, OH 43216
OhioSoS.gov
Expedite Filing (Two business day processing time.
business@OhioSoS.gov
Requires an additional $100.00)
P.O. Box 1390
File online or for more information:
OhioBusinessCentral.gov
Columbus, OH 43216
For screen readers, follow instructions located at this path.
Certificate of Surrender
Foreign Licensed Corporation
(For-Profit or Nonprofit Foreign Corporation)
Filing Fee: $50
(143-SUR)
Form Must Be Typed
Complete the following information.
The foreign corporation, listed below, surrenders its license to transact business in Ohio.
Name of Corporation
Jurisdiction of Formation
Ohio License Number
The address to which the secretary of state may mail any process against such corporation that may be served upon
the secretary of state, and may mail any other notices, certificates, or statements:
Mailing Address
City
ZIP Code
State
Last Revised: 11/2019
Form 564
Page 2 of 6
By signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she
has the requisite authority to execute this document.
Required
Signature
Must be signed by an authorized
officer, or by the receiver,
trustee in bankruptcy,
or other liquidator of such
By (if applicable)
corporation.
If authorized representative
is an individual, then they
must sign in the "signature"
Print Name
box and print their name
in the "Print Name" box.
If authorized representative
is a business entity, not an
individual, then please print
Signature
the business name in the
"signature" box, an
authorized representative
of the business entity
By (if applicable)
must sign in the "By" box
and print their name in the
"Print Name" box.
Print Name
Signature
By (if applicable)
Print Name
Last Revised: 11/2019
Form 564
Page 3 of 6
Complete the information in this section.
AFFIDAVIT BY A FOREIGN CORPORATION
In lieu of dissolution releases from various governmental authorities (ORC section 1703.17(D)).
Name of Corporation
The undersigned, being first duly sworn, declares that on the dates indicated below, each of the named state governmental
agencies was advised IN WRITING of the scheduled date of filing of the Certificate of Surrender and was advised IN
WRITING of the acknowledgement by the corporation that the surrender of its license does not release it of liability, if any, for
payment of taxes and contributions due.
Agency
Agency
Date Notified
Date Notified
(MM/DD/YYYY)
(MM/DD/YYYY)
Ohio Department of Taxation
Ohio Job & Family Services
Dissolution Section
Status and Liability Section
4485 Northland Ridge Blvd.
Data Correspondence Control
Columbus, Ohio 43229
Fax:
614-752-4811
Phone: 614-466-2319
Regular Address:
Overnight Address:
P.O. Box 182413
P.O. Box 182413
Columbus, OH 43218-2413
Columbus, OH 43218-2413
Treasurer
Date Notified
The treasurer of any county named below:
(MM/DD/YYYY)
Note: This affidavit must be signed by a person executing the certificate of surrender or by an officer of the corporation.
Signature
Title
Name
Mailing Address
City
ZIP Code
State
Sworn to and subscribed in my presence on this date (MM/DD/YYYY)
Seal
Notary Public
Date Commission Expires (MM/DD/YYYY)
Last Revised: 11/2019
Form 564
Page 4 of 6
Complete the information in this section.
AFFIDAVIT OF PERSONAL PROPERTY
State of
County of
SS:
, being first duly sworn, deposes and says that she/he is
Name of Officer
of
Title of Officer
Name of Corporation
and this affidavit is made in compliance with section 1703.17 of the Ohio Revised Code.
That said corporation has: (Check one (1) of the following)
A. Has no personal property in any county in the state of Ohio
B. Has personal property in the following county(ies)
County
County
County
and that the net assets of said corporation are sufficient to pay all personal property taxes accrued to date.
Signature
Title
Seal
Sworn to and subscribed in my presence on this date (MM/DD/YYYY)
Notary Public
Date Commission Expires (MM/DD/YYYY)
Last Revised: 11/2019
Form 564
Page 5 of 6
Page of 6