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Reset Restatement OF WITHDRAWAL OF A FILING State Form 56366 (817) Approved by State Board of Accounts, 2017INSTRUCTIONS:SECRETARY OF STATE BUSINESS SERVICES DIVISION 302 West Washington Street, Room

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How to fill out statement of withdrawal of

01

Step 1: Write your personal information at the top of the statement, including your full name, address, and contact details.

02

Step 2: Clearly state the purpose of the statement, which is to withdraw from a particular agreement, program, or membership.

03

Step 3: Provide details about the agreement, program, or membership you wish to withdraw from, such as the name of the organization, the date of enrollment, and any relevant identification numbers.

04

Step 4: Explain your reasons for wanting to withdraw, providing a clear and concise explanation. It is important to be honest and specific in your explanation.

05

Step 5: Request any necessary actions to be taken on the part of the organization, such as canceling any recurring payments, removing your name from mailing lists, or closing your account.

06

Step 6: Sign and date the statement at the bottom, and include any supporting documentation if required.

07

Step 7: Keep a copy of the statement for your records and send the original via certified mail or another traceable method to ensure delivery and proof of receipt.

Who needs statement of withdrawal of?

01

Anyone who wishes to formally withdraw from an agreement, program, or membership can use a statement of withdrawal.

02

Individuals who want to terminate a contract, discontinue a service, or cancel a membership may need to provide a statement of withdrawal as part of the process.

03

Organizations or institutions that require formal notification of an individual's decision to withdraw from a program or membership may also request a statement of withdrawal.

04

It is advisable to check the specific requirements of the agreement, program, or membership in question to determine if a statement of withdrawal is necessary.

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