West Virginia > Secretary Of State > Business Organizations > Multiple Company Types
Annual Attorney In Fact Filing IA-1 - West Virginia
| Annual Attorney In Fact Filing Form. This is a West Virginia form and can be used in Multiple Company Types Business Organizations Secretary Of State . |
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Natalie E. Tennant Secretary of State 1900 Kanawha Blvd E. Bldg 1, Suite 157-K Charleston, WV 25305 FILE ONE ORIGINAL FEE: $25.00 2011 ANNUAL ATTORNEY-IN-FACT FILING Penney Barker, Manager Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 www.wvsos.com Hrs: 8:30 a.m. 5:00 p.m. ET The name of the Insurance Company is: __________________________________________ Below you will find the information that is requested for your registered insurance company's annual filing. Please complete and return to our office along with the twenty-five dollar ($25) attorney-in-fact fee by July 1, 2010 as required by §33-4-12 of the West Virginia Code. The check should be made payable to "WV Secretary of State." Please notice the signature line. If you change the agent for process, we will need a signature or written consent from the agent being appointed. This is a requirement of §31D-5-502 and §33-4-12 of the West Virginia Code. 1. Principal Office Address: ______________________________________________ ______________________________________________ ______________________________________________ 2. Registered Agents Name and Address For Service of Process: ______________________________________________ ______________________________________________ ______________________________________________ 3. Signature of New Agent consenting to the appointment (if applicable): Signature/Title of person authorized to sign on behalf of the company. ______________________________________________ 4. ______________________________________________ Signature/Title Mail the form and $25 check to the address on the top of the form. Thank you for your attention to this matter. If you have any questions regarding this mailing, please contact our office and ask to speak with a member of our Business and Licensing Division at 304-5588000. Form IA-1 Issued by the Office of the Secretary of State Revised 1/11 American LegalNet, Inc. www.FormsWorkFlow.com
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