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Statement Appointing An Agent Form. This is a Colorado form and can be use in Corporation Secretary Of State.
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Tags: Statement Appointing An Agent, Colorado Secretary Of State, Corporation
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If document is filed on paper
$150.00
If document is filed electronically
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Fees & forms/cover sheets
are subject to change.
To file electronically, access instructions
for this form/cover sheet and other
information or print copies of filed
documents, visit www.sos.state.co.us
and select Business Center.
Paper documents must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
Statement Appointing an Agent
filed pursuant to §7-90-301, et seq. and §7-30-110 of the Colorado Revised Statutes (C.R.S.)
1. True name of the nonprofit association:
______________________________________________________
2. Principal office street address:
______________________________________________________
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
_______________________ ______________
(Province – if applicable)
3. Principal office mailing address:
(if different)
(Postal/Zip Code)
(Country – if not US)
______________________________________________________
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
_______________________ ______________
(Province – if applicable)
3. Registered agent:
(if an individual):
(Postal/Zip Code)
(Country – if not US)
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
OR (if a business organization):
______________________________________________________
4. The person appointed as registered agent in the document has consented to being so appointed.
5. Registered agent street address:
______________________________________________________
(Street name and number)
______________________________________________________
__________________________ _CO_ ____________________
(City)
6. Registered agent mailing address:
(if different from above)
(State)
(Postal/Zip Code)
______________________________________________________
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
7. (Optional) Delayed effective date:
(Country – if not US)
______________
(mm/dd/yyyy)
UNA_AGT
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Rev. 9/21/2005
American LegalNet, Inc.
www.USCourtForms.com
Notice:
Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the
individual's act and deed, or that the individual in good faith believes the document is the act and deed of the
person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity
with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic
statutes, and that the individual in good faith believes the facts stated in the document are true and the
document complies with the requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the secretary of
state, whether or not such individual is named in the document as one who has caused it to be delivered.
8. Name(s) and address(es) of the
individual(s) causing the document
to be delivered for filing:
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
(The document need not state the true name and address of more than one individual. However, if you wish to state the name and address
of any additional individuals causing the document to be delivered for filing, mark this box
name and address of such individuals.)
and include an attachment stating the
Disclaimer:
This form, and any related instructions, are not intended to provide legal, business or tax advice, and are
offered as a public service without representation or warranty. While this form is believed to satisfy minimum
legal requirements as of its revision date, compliance with applicable law, as the same may be amended from
time to time, remains the responsibility of the user of this form. Questions should be addressed to the user’s
attorney.
UNA_AGT
Page 2 of 2
Rev. 9/21/2005
American LegalNet, Inc.
www.USCourtForms.com
