Change Of Agent (Foreign All Entities Except LP)

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; 34-224; 34-408; 34-429; 34-532 USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY. FILING PARTY (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" NAME: 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 OR COMPLETE B) 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. NAME OF AGENT (SEE INSTRUCTIONS): SIGNATURE ACCEPTING APPOINTMENT (IF AGENT IS A BUSINESS ALSO PRINT NAME AND TITLE OF PERSON SIGNING.)*: BUSINESS ADDRESS: (P.O.BOX UNACCEPTABLE) CONNECTICUT RESIDENCE ADDRESS: (P.O.BOX UNACCEPTABLE) ADDRESS: ADDRESS: CITY: STATE: ZIP: CITY: STATE: ZIP: PAGE 1 OF 2 FORM ACS-1-1.0 Rev. 11/23/2010 American LegalNet, Inc. www.FormsWorkFlow.com 5. EXECUTION: (SUBJECT TO PENALTY OF FALSE STATEMENT): DATED THIS NAME OF SIGNATORY DAY OF CAPACITY/TITLE OF SIGNATORY , 20 SIGNATURE PAGE 2 OF 2 FORM ACS-1-1.0 Rev. 11/23/2010 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS 1. Name of business entity in state or country of formation: Please provide the complete name of the business entity. 2. The name under which the business entity transacts business in Connecticut: 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. State/Country of formation: Please provide the business entity's state or country of formation. 4. Appointment of NEW agent for service of process: 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 or her business and a Connecticut residence address. If none, MUST state "NONE") or 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 4B. · 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. 5. Execution: 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 FORM ACS-1-1.0 Rev. 11/23/2010 American LegalNet, Inc. www.FormsWorkFlow.com