Transcription of THIS FORM MUST BE PROPERLY SIGNED AND NOTARIZED
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Example: bachelor of science
THIS FORM MUST BE PROPERLY SIGNED AND NOTARIZED
PLEASE PRINT OR TYPE INFORMATIONNO FILING FEES worn to and subscribed before me this(Signature of Affiant)TITLE(Present address of Affiant)Telephone Number ( )day of , year(Notary Public, District Justice or Authorized Agent,Department of Revenue)My commission expires, year(Notary Signature and Seal)REV-238 CM (04-13)OUT OF EXISTENCE/WITHDRAWALAFFIDAVITPLEASE PRINT OR TYPE INFORMATIONDEPARTMENT USE ONLYR evenue IDBUREAU OF COMPLIANCEOUT OF EXISTENCE/MERGER SECTIONPO BOX 280947 HARRISBURG PA 17128-0947717-783-6052TT# 800-447-3020 (Services for taxpayerswith special hearing and/or speaking needs only)THIS FORM MUST BE PROPERLY SIGNED AND NOTARIZEDNOTE: If filing a final RCT-101 corporate report for 2002 and forward, complete the corporate status change section in theRCT-101 in lieu of filing this form.
OUT OF EXISTENCE/WITHDRAWAL AFFIDAVIT PLEASE PRINT OR TYPE INFORMATION DEPARTMENT USE ONLY Revenue ID BUREAU OF COMPLIANCE OUT OF EXISTENCE/MERGER SECTION PO BOX 280947 HARRISBURG PA 17128-0947 717-783-6052 TT# 800-447-3020 (Services for taxpayers with special hearing and/or speaking needs only) …
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