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Initial List Of Trustees And Resident Agent Of Business Trust Form. This is a Nevada form and can be use in Business Trust Secretary Of State.
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INITIAL LIST OF TRUSTEES AND REGISTERED AGENT AND
STATE BUSINESS LICENSE OF:
FILE NUMBER
NAME OF BUSINESS TRUST
FOR THE FILING PERIOD OF
*100703*
TO
**YOU MAY FILE THIS FORM ONLINE AT www.nvsos.gov**
*100703*
The entity's duly appointed registered agent in the State of Nevada upon whom process can be served is:
A FORM TO CHANGE REGISTERED AGENT INFORMATION IS FOUND AT: www.nvsos.gov
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
Return one file stamped copy. (If filing not accompanied by order instructions, file stamped copy will be sent to registered agent.)
IMPORTANT: Read instructions before completing and returning this form.
1. Print or type names and addresses, either residence or business, for all trustees. A Trustee must sign the form. FORM WILL BE RETURNED IF UNSIGNED.
2. If there are additional trustees, attach a list of them to this form.
3. Return completed form with filing fee of $125.00. A $75.00 penalty must be added for failure to file this form by the last day of the first month following registration date.
4. State business license fee is $200.00. Effective 2/1/2010, $100.00 must be added for failure to file form by deadline.
5. Make your check payable to the Secretary of State.
6. Ordering Copies: If requested above, one file stamped copy will be returned at no additional charge. To receive a certified copy, enclose an additional $30.00 per certification.
A copy fee of $2.00 per page is required for each additional copy generated when ordering 2 or more file stamped or certified copies. Appropriate instructions must
accompany your order.
7. Return the completed form to: Secretary of State, 202 North Carson Street, Carson City, Nevada 89701-4201, (775) 684-5708.
8. Form must be in the possession of the Secretary of State on or before the last day of the first month following the initial registration date. (Postmark date is not accepted as
receipt date.) Forms received after due date will be returned for additional fees and penalties. Failure to include initial list and business license fees will result in rejection of
filing.
INITIAL LIST FILING FEE: $125.00
LATE PENALTY: $75.00
BUSINESS LICENSE FEE: $200.00
LATE PENALTY: $100.00
Complete only if applicable
NRS 76.020 Exemption Codes
001 - Governmental Entity
Pursuant to NRS Chapter 76, this entity is exempt from the business license fee. Exemption code:
003 - Home-based Business
NOTE: If claiming an exemption, a notarized Declaration of Eligibility form must be attached. Failure to
attach the Declaration of Eligibility form will result in rejection, which could result in late fees.
NAME
005 - Motion Picture Company
006 - NRS 680B.020 Insurance Co.
TITLE(S)
TRUSTEE
ADDRESS
CITY
STATE
NAME
ZIP CODE
TITLE(S)
STATE
ZIP CODE
STATE
ZIP CODE
STATE
ZIP CODE
TRUSTEE
ADDRESS
CITY
NAME
TITLE(S)
TRUSTEE
ADDRESS
CITY
NAME
TITLE(S)
TRUSTEE
ADDRESS
CITY
I declare, to the best of my knowledge under penalty of perjury, that the above mentioned entity has complied with the provisions of NRS Chapter 76 and
acknowledge that pursuant to NRS 239.330, it is a category C felony to knowingly offer any false or forged instrument for filing in the Office of the Secretary of
State.
X
Signature of Trustee
Title
Date
Nevada Secretary of State Initial List Trustee
Revised: 7-5-11
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