Statement Of Change Of Registered Agent By Represented Entity Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Statement Of Change Of Registered Agent By Represented Entity Form. This is a Nevada form and can be use in Corporation Secretary Of State.
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Tags: Statement Of Change Of Registered Agent By Represented Entity, Nevada Secretary Of State, Corporation
ROSS MILLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684 5708
Website: www.nvsos.gov
Statement of Change of
Registered Agent
by Represented Entity
(PURSUANT TO NRS 77.340)
This form may be submitted by: the Represented Entity to appoint a
new Registered Agent or amend own service of process info. For more
information please visit http://www.nvsos.gov/business/forms/ra.asp
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
1. Name of Represented Entity:
2. Entity File Number:
3. This statement of change will have the following effect: (check only one)
Appoints a new agent for service of process (complete 4a or 4b)
Updates contact information of the Represented Entity acting as own agent (complete 4c)
4. Information in effect upon the filing of this statement: (complete only one section)
a) Commercial Registered Agent:
Name
b) Noncommercial Registered Agent:
Name
Nevada
Street Address
City
Mailing Address (if different from street address)
Zip Code
City
Nevada
Zip Code
c) Title of Office or Other Position within Represented Entity:
Name of Title or Position
Nevada
Street Address
City
Mailing Address (if different from street address)
Zip Code
City
Nevada
Zip Code
5. Signature of Represented Entity: (required)
X
Authorized Signature
Date
6. Registered Agent Acceptance: (required)
I hereby accept appointment as Registered Agent for the above named Entity.
X
Authorized Signature of Registered Agent or On Behalf of Registered Agent Entity
FEE: $60.00
This form must be accompanied by appropriate fees.
Date
Nevada Secretary of State Form RA Change by Entity
Effective 12-22-08
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