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Items 1 - 6 — Submit the completed form in duplicate along with the filing fee and appropriate certificate of account status. Instructions: • Complete and include this form with your paper submission.Complete and file the Certificate of Withdrawal with the Department of State. Application for Certificate of Withdrawal for a Foreign Non-Profit Corporation. Section 7-6-83 of the General Laws of Rhode Island, 1956, as amended. I declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct. Signature of Authorized Representative. Withdrawal from the state of Wyoming. 1. To do so, you can file an Application for a Certificate of Withdrawal. Withdrawal Filing.