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Consent To Service Of Process Form. This is a Connecticut form and can be use in Blue Sky Secretary Of State.
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Tags: Consent To Service Of Process, CT-4, Connecticut Secretary Of State, Blue Sky
Form CT-4
CONSENT TO SERVICE OF PROCESS
1. Pursuant to The Connecticut Uniform Securities Act, both foreign and domestic applicants must complete this form.
2. Corporations must complete Parts I and II.
3. Individuals must complete Parts I and III.
_________________________________________________________________________________________________
PART I
KNOW ALL MEN BY THESE PRESENTS:
That the undersigned,______________________________________________________________ (a corporation
organized under the laws of the State of _______________________________________ (a partnership) (an individual)
(other,_______________________________________) for the purpose of complying with the laws and regulations of the
State of Connecticut, hereby irrevocably appoints The Banking Commissioner of the State of Connecticut, and
thesuccessors in such office, its attorney in the State of Connecticut upon whom may be served any notice, process or
COURT
pleading in any action or other proceeding against it arising out of or in connection with the issuance, offer to sell, or sale of
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
securities or out of violation of the aforesaid laws or regulations of said State; and the undersigned does hereby consent that
:
Index No.
any such action or proceeding against it may be commenced in any court of competent jurisdiction and proper venue within
said State or in any administrative agency by service or process upon said :
officer with the same effect as if the undersigned
Calendar No.
had lawfully been served with process or notice in said State.
:
JUDICIAL to:
Plaintiff(s)
It is requested that a copy of any notice, process or pleading served hereunder be mailed SUBPOENA
-against:
_________________________________________________________
(Name and Address) :
_________________________________________________________
:
Defendant(s)
:
Dated:_____________________________________________, 20____
......................................................
(Seal)
By_________________________________________________
Title:_______________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
By_________________________________________________
TO
Title:_______________________________________________
_________________________________________________________________________________________________
PART II - CORPORATE ACKNOWLEDGMENT
GREETINGS:
STATE OF____________________________________)
) ss.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
COUNTY OF __________________________________)
,
the Honorable
at the
Court
located at
County of
On this ________________ day of _____________________, 20____ , before me, the undersigned officer,
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
personally appeared ____________________________________and __________________________________, known
or adjourned be theto testify and give evidence as and _____________Secretary, respectively, of the above named
date, ________________President a witness in this action on the part of the
personally to me to
corporation, and that they, as such officers, being authorized so to do, executed the foregoing instrument for the purposes
therein contained, be signing the name of the corporation by themselves as such officers.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
IN WITNESS WHEREOF I subpoena was issued for and official penalty of $50 and all damages sustained as a
the party on whose behalf thishave hereunto set my hand a maximum seal.
result of your failure to comply.
(Notarial Seal)
Notary Public__________________________________________
My Commission expires:_________________________________
Witness, Honorable
, one of the Justices of the
Court in
County,
day of
, 20
_________________________________________________________________________________________________
PART III - INDIVIDUAL OR PARTNERSHIP ACKNOWLEDGMENT
STATE OF____________________________________)
)
COUNTY OF __________________________________)
(Attorney must sign above and type name below)
ss.
Attorney(s) for
On this ________________ day of _____________________, 20____ , before me, the undersigned officer,
personally appeared ____________________________________, to me personally known and known to be the same
person(s) whose name(s) is (are) signed to the foregoing instrument, and acknowledged the execution thereof for the uses
and purposes therein set forth.
Office and P.O. Address
IN WITNESS WHEREOF I have hereunto set my hand and official seal.
(Notarial Seal)
Telephone No.:
Notary Public__________________________________________
Facsimile No.:
My Commission expires:_________________________________
E-Mail Address:
Mobile Tel. No.:
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