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Termination Of Registration As Paid Solicitor Agent S2A - Georgia
| Termination Of Registration As Paid Solicitor Agent Form. This is a Georgia form and can be used in Securities And Business Regulation Blue Sky Secretary Of State . |
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Professional Licensing Boards and Securities Division 237 Coliseum Drive Macon, GA 31217-3858 (478) 207-2440 http://www.sos.state.ga.us/securities/ Brian P. Kemp Secretary of State Eric R. Lacefield Division Director Termination of Registration As A Paid Solicitor Agent Part I - Employer Name of Paid Solicitor Registration Number Main Address (Number and Street) City State Zip Code Office of Employment Address (Number and Street) City State Zip Code Person to Contact Regarding This application Phone Number Part II - Applicant (Solicitor Agent) A. B. C. Name (Last) (First) (Full Middle or Maiden Name - specify if none) Social Security Number Date Terminated Reason - Check One: Voluntary Deceased Discharged Part III (Signature and Title of Official for Paid Solicitor) (Date) Form S2A Revised Aug 2012 American LegalNet, Inc. www.FormsWorkFlow.com
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