(1) The name of the foreign corporation and the state or country under the laws of which it is incorporated;

(2) That the foreign corporation is not transacting business in this State;

(3) That the foreign corporation surrenders its authority to transact business in this State;

(4) That the foreign corporation revokes the authority of its registered agent in this State to accept service of process and consents that service of process in any action, suit, or proceeding based upon any cause of action arising in this State during the time the corporation was authorized to transact business in this State may thereafter be made on the corporation by service thereof on the director;

(5) The dates that notice of the foreign corporation's intent to withdraw from the State was published, once in each of four successive weeks (four publications) in a newspaper of general circulation published in the State or a statement that publication was not made;

(6) That all taxes, debts, obligations, and liabilities of the foreign corporation in this State have been paid and discharged or that adequate provision has been made therefor;

(7) A mailing address to which the director may mail a copy of any process against the foreign corporation that may be served on the director; and

(8) Such additional information as may be necessary or appropriate in order to enable the director to determine and assess any unpaid fees payable by the foreign corporation as in this chapter prescribed.