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Change Of Agent (Foreign All Entities) - Connecticut

Change Of Agent (Foreign 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 Foreign (FORMED OUTSIDE OF CONNECTICUT) All Entities C.G.S. §§ 33-927; 33-1217; 34-38p; 34-243n; 34-408; 34-429; 34-532 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: 1. NAME OF BUSINESS ENTITY IN STATE OR COUNTRY OF FORMATION: 2. THE NAME UNDER WHICH THE BUSINESS ENTITY TRANSACTS BUSINESS IN CONNECTICUT, IF DIFFERENT FROM NAME STATED IN NUMBER 1 ABOVE, (IF APPLICABLE): 3. STATE/COUNTRY OF FORMATION: 4. APPOINTMENT OF NEW AGENT FOR SERVICE OF PROCESS: THE BUSINESS ENTITY MAY NOT BE APPOINTED AS ITS OWN AGENT; HOWEVER A PRINCIPAL OF THE BUSINESS ENTITY RESIDING IN CONNECTICUT MAY BE THE AGENT. (CHECK A COMPLETE B OR SEE #5 IF APPLICABLE) A. THE BUSINESS ENTITY APPOINTS THE SECRETARY OF THE STATE OF CONNECTICUT AND HIS/ HER SUCCESSORS IN OFFICE TO BE ITS AGENT, UPON WHOM ANY PROCESS, IN ANY ACTION OR PROCEEDING AGAINST IT, MAY BE SERVED. B. IF AGENT IS AN INDIVIDUAL: PRINT OR TYPE FULL LEGAL NAME: BUSINESS ADDRESS: STREET: (P.O.BOX UNACCEPTABLE) CONNECTICUT RESIDENCE ADDRESS: (P.O.BOX UNACCEPTABLE) (IF NONE, MUST STATE "NONE") STREET: CITY: STATE: ZIP: CITY: STATE: ZIP: SIGNATURE ACCEPTING APPOINTMENT: X PAGE 1 OF 2 Rev. 7/2017 American LegalNet, Inc. www.FormsWorkFlow.com (DO NOT COMPLETE 4C IF AGENT APPOINTED AT 4A OR 4B) C. IF AGENT 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: 5. CONNECTICUT MAILING ADDRESS OF REGISTERED AGENT :( REQUIRED FOR FOREIGN LIMITED LIABILITY COMPANIES ONLY ) ( P.O. BOX IS ACCEPTABLE ) STREET OR PO BOX: CITY: STATE: ZIP: 6. EXECUTION: (SUBJECT TO PENALTY OF FALSE STATEMENT) DATE (MM/DD/YYYY) NAME OF SIGNATORY CAPACITY/TITLE OF SIGNATORY SIGNATURE PAGE 2 OF 2 Rev. 7/2017 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS 1. Please provide the complete name of the business entity. 2. Provide the complete name under which the business entity transacts business in Connecticut as it currently appears on the records of the Secretary of the State if other than the name stated in item number 1. 3. Please provide the business entity's state or country of formation. 4. The business entity may appoint either: A. The Secretary of the State OR B. 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/her business (if none, must state "none") and a Connecticut residence Address. Agent must sign accepting the appointment. OR · 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 4B. · Print the name & title under the signature of the individual signing acceptance on behalf of the business agent. 5. A foreign limited liability company must provide the agent's Connecticut mailing address (if the Secretary of the State is not appointed agent). 6. The document must be executed/signed by an authorized official of the business entity. That person must print or type their name, state the capacity/title under which they sign and provide a 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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