The Uniform Certificate of Authority Statement of Withdrawal Application should be used to file a complete Surrender of the. Certificate of Authority. The.Submit letter to Department requesting withdrawal. Submit UCAA Form 17, Statement of Withdrawal. Minors age 14, 15, 16 and 17, are REQUIRED to be present in Court with a picture ID for all matters. This can be a current school ID or an Illinois State ID. DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files. A full withdrawal is when you are withdrawing from all of the jurisdictions with which you are registered (or have an application pending). Please send the completed withdrawal form to: Illinois Department of Financial and Professional Regulation. 320 W Washington St, 3rd Floor.