Connecticut Withdrawal Guarantee Declaration for Corporations

Withdrawal Guarantee Declaration for Corporations
AU-800A, Withdrawal Guarantee Declaration for Corporations
Withdrawal Guarantee Declaration for Corporations
I, _________________________________________________________________, state that:
(Name)

1. I am the _____________________________________________________________ of
(Title)

________________________________________________ and I am duly authorized to
(Name of Corporation)

execute this declaration on behalf of the corporation.
2. The corporation assumes liability for and guarantees the filing of all tax returns due to
the State of Connecticut from ______________________________________________
(Name of Withdrawing Corporation)

as well as full payment of all taxes lawfully assessed for any taxable period during which
the company was subject to these taxes according to the Connecticut General Statutes.
3. The Internal Revenue Services has audited the United States corporation income tax
returns of the corporation through the taxable year ending ______________.
(Year)

All corrections resulting from these audits have been reported to the Commissioner of
Revenue Services on the prescribed form as required by Section 12-226 of the
Connecticut General Statutes.
4. The _____________________________________ discontinued business operations in
(Name of Withdrawing Corporation)

Connecticut on or about ________ and has held no property in the state since _______.
(Date)

(Date)

5. It is stipulated and agreed that this commitment to pay any taxes legally assessed and
due from the corporation will not be affected by the granting of a Certificate of
Withdrawal by the Secretary of the State of Connecticut.

Declaration:

I declare under penalty of law that I have examined this declaration (including any
accompanying schedules and statements) and, to the best of my knowledge and belief, it is true,
complete, and correct. I understand the penalty for willfully delivering a false return, statement, or
document to Department of Revenue Services (DRS) is a fine of not more than $5,000, or imprisonment
for not more than five years nor less than one year, or both. The declaration of a paid preparer other
than the taxpayer is based on all information of which the preparer has any knowledge.

__________________________ ___________________________
(Signature of Principal Officer)

AU-800A (Rev. 03/08)

(Title)

__________________
(Date)