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Resignation Of Agent DSCB 15-9120 - Pennsylvania

Resignation Of Agent Form. This is a Pennsylvania form and can be used in Unincorporated Nonprofit Association Department Of State .
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PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Agent for Service of Process (15 Pa.C.S. § 9120) Resignation of Agent Name Address City State Zip Code Unincorporated Nonprofit Association Document will be returned to the name and address you enter to the left. Fee: $40 In compliance with the requirements of 15 Pa.C.S. § 9120(d) (relating to resignation of agent to receive service of process), the undersigned agent hereby states that: 1. The name of the unincorporated nonprofit association is: 2. The last known address, if any, in this Commonwealth of the above-named association is: Number and Street City State Zip County 3. The name and address in this Commonwealth of the resigning agent (the person currently authorized to receive service of process for the above-named association) is: Name Number and Street City State Zip County 4. I resign as the person authorized to receive service of process for the above-named association. IN TESTIMONY WHEREOF, the undersigned Agent has caused this Resignation of Agent for Service of Process to be executed this day of , . ____________________________________________ Name of Agent ____________________________________________ Signature ____________________________________________ Title 8/2013 American LegalNet, Inc. DSCB:15-9120D-2 Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 Web site: Instructions for Completion of Form: A. Typewritten is preferred. If not, the form shall be completed in black or blue-black ink in order to permit reproduction. The filing fee for this form is $40.00 and should be made payable to the Commonwealth of Pennsylvania. Checks must contain a commercially pre-printed name and address. B. Under 15 Pa.C.S. § 135(c) (relating to addresses) an actual street or rural route box number must be used as an address, and the Department of State is required to refuse to receive or file any document that sets forth only a post office box address. C. Resignation of an agent for service of process must be signed by the person resigning as the agent. In addition to filing this form with the Department, the resigning agent must also give notice of the resignation to the nonprofit association. D. This form and all accompanying documents shall be mailed to the address stated above. American LegalNet, Inc.
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