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Change Of Agent (Domestic All Entities) - Connecticut

Change Of Agent (Domestic All Entities) Form. This is a Connecticut form and can be used in General Secretary Of State .
 Fillable pdf Last Modified 3/9/2011
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SECRETARY OF THE STATE OF CONNECTICUT MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470 DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106 PHONE: 860-509-6003 WEBSITE: www.concord-sots.ct.gov CHANGE OF AGENT DOMESTIC (DOMESTIC FORMED IN CONNECTICUT) ALL ENTITES C.G.S. § 33-661; 33-1051; 34-13b; 34-243n; 34-408; 34-507 USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY NAME: (CONFIRMATION WILL BE SENT TO THIS ADDRESS): FILING FEE: $50 EXCEPTION: $20.00 FILING FEE FOR NONSTOCK (NONPROFIT) CORPORATIONS & LIMITED PARTNERSHIPS. MAKE CHECKS PAYABLE TO "SECRETARY OF THE STATE" MAILING ADDRESS: CITY: STATE: ZIP: (MUST MATCH OUR RECORDS EXACTLY. INCLUDE BUSINESS DESIGNATION I.E. L.L.C., LLC, 1. NAME OF ENTITY - REQUIRED: INC, ETC.): 2. APPOINTMENT OF NEW AGENT: A. IF AGENT IS AN INDIVIDUAL: (COMPLETE A OR B, NOT BOTH) PRINT OR TYPE FULL LEGAL NAME: BUSINESS ADDRESS (P.O.BOX UNACCEPTABLE) IF NONE, MUST STATE "NONE" STREET: CONNECTICUT RESIDENCE ADDRESS (P.O.BOX UNACCEPTABLE) STREET: CITY: STATE: ZIP: CITY: STATE: ZIP: CONNECTICUT MAILING ADDRESS OF REGISTERED AGENT : ( REQUIRED FOR LIMITED LIABILITY COMPANIES ONLY ): ( PO BOX IS ACCEPTABLE ) STREET OR PO BOX: CITY: STATE: ZIP: SIGNATURE ACCEPTING APPOINTMENT: X PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com Rev. 7/2017 NOTE: DO NOT COMPLETE 2B IF 2A IS COMPLETED B. IF AGENT IS A BUSINESS: PRINT OR TYPE NAME OF BUSINESS AS IT APPEARS ON OUR RECORDS: CONNECTICUT BUSINESS ADDRESS STREET: (P.O.BOX UNACCEPTABLE) CITY: STATE: ZIP: SIGNATURE ACCEPTING APPOINTMENT ON BEHALF OF AGENT: X PRINT NAME & TITLE OF PERSON SIGNING ON BEHALF OF AGENT: CONNECTICUT MAILING ADDRESS OF REGISTERED AGENT : ( REQUIRED FOR LIMITED LIABILITY COMPANIES ONLY ): ( PO BOX IS ACCEPTABLE ) STREET OR PO BOX: CITY: STATE: ZIP: 3.EXECUTION: (SUBJECT TO PENALTY OF FALSE STATEMENT) DATE (MM/DD/YYYY) NAME OF SIGNATORY (print/type) CAPACITY/TITLE OF SIGNATORY SIGNATURE PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com Rev. 7/2017 INSTRUCTIONS 1. Name of entity: Please provide the complete name of the business entity, as it appears on the records of The Secretary of the State. Include business designation (i.e. LLC, Inc, etc.) (MUST MATCH OUR RECORDS EXACTLY) 2. Appointment of new agent: The business entity may appoint either: A. Any individual who is a resident of Connecticut, including a principal of the business entity. (An individual must provide the complete street address of his or her business (If none, MUST state "NONE") and a Connecticut residence address. Appointed agent must sign acceptance of appointment. or B. Any of the following business types, on record with this office: · A Connecticut corporation, limited liability company, limited liability partnership or statutory trust · A foreign corporation, limited liability company, limited liability partnership or statutory trust, which has obtained a certificate of authority to transact business in Connecticut and has a Connecticut address on file with this office · The business must provide a Connecticut business address in Box 2B. · Print the name & title under the signature of the individual signing acceptance on behalf of the business agent. NOTE: The entity may NOT appoint itself as its registered agent. NOTE: LLC's must provide a Connecticut mailing address of appointed agent. If the entity at line 1 is a domestic/Connecticut Limited Liability Company, it must provide the agent's Connecticut mailing address (which may be a PO BOX). 3. Execution: The document must be executed/signed by an authorized official of the business entity. That person must print or type his or her full legal name, state the capacity/title under which he/she signs and provide his/her signature. The execution constitutes a legal statement under the penalties of false statement that the information provided in the document is true. OFFICE OF THE SECRETARY OF THE STATE MAILING ADDRESS: COMMERCIAL RECORDING DIVISION CONNECTICUT SECRETARY OF THE STATE P.O. BOX 150470 HARTFORD, CT 06115-0470 DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION CONNECTICUT SECRETARY OF THE STATE 30 TRINITY STREET HARTFORD, CT 06106 PHONE: 860-509-6003 WEBSITE: www.concord-sots.ct.gov INSTRUCTIONS DO NOT SCAN THIS PAGE Rev. 7/2017 American LegalNet, Inc. www.FormsWorkFlow.com
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