Submit UCAA Form 17, Statement of Withdrawal. Return of the original Illinois Certificate of Authority for cancellation.020) since January 1, 1995. All forms are in PDF format and are fillable (you can type in them). We recommend that you type the information so the documents are legible. Phoenix, AZ 85038-9026. For assistance in the Phoenix area: (602) 364-0380 or outside the Phoenix area toll free: (877) 492-9957. Fill out all of this form and other papers you are attaching before you sign this form in front of a notary. All documents are PDF format. The Trust or Escrow Account and Authorization for Release of Information form (Authorization form) should be filled out as follows: 1).