Form C-104e Rev. 3/96 CERTIFICATE OF RESIGNATION OF REGISTERED AGENT FOR ..................................................................................................................................................... (Corporation) (FOR USE BY REGISTERED AGENTS OF DOMESTIC OR FOREIGN CORPORATIONS) To: New Jersey Department of the Treasury, Division of Revenue In accordance with the provisions of Section 14A:4-4(2), Corporations, General, of the New Jersey Statutes, I, .................................................................................. Registered Agent at .......................................................................... ................................................ .................... (No. and Street) (City and State) (Zip Code) the address of the registered office of the above-named corporation, incorporated under the laws of ............................................................................. DO HEREBY DECLARE that: (Name of State) 1. I sent my resignation by certified mail, number ........................................ , recorded at the (Cert. Mail #) ................................................. Post Office with return receipt requested, to .................................... (City and State of Post Office) (President, Vice-Pres., Sec. or Treas.) (Name) being the last .................................... of said corporation known to me, at the last address known to me at .................................................................................... ...................................................... ...................... (No. and Street) (City and State) (Zip Code) Certified mail was ___ accepted by ........................................................ (Date) ___ not accepted 2. Attached is a copy of my resignation mailed on ........................................ (Omit if not applicable) 3. Service of notice of my resignation has not been made as required. Such service cannot be made because: 4. It is understood that my resignation shall become effective upon the expiration of 30 days after the filing of this certificate in the Office of the Treasurer or upon the designation by the corporation of a new registered agent, whichever is earlier. Beginning with the effective date of my resignation, this certificate is authorization for the Treasurer to accept service of process under N. J. S. 2A:15- 26 through N.J. S. A.2A:15-30 until the corporation files a certificate setting forth the name of a new Registered Agent. ................................................................... (Signature of Agent of Record) ......................... (Date) NOTE: Pursuant to NJSA 14A:4-3 and NJSA 14A:4-3(4), failure to file a Certificate of Change of Registered Agent or Office or both may result in a penalty imposed by the State Attorney General. NJ Division of Revenue, PO Box 308, Trenton, NJ 08646 American LegalNet, Inc. www.USCourtForms.com (Rev 7/18/05) Instructions for Form C-104E CERTIFICATION OF RESIGNATION OF REGISTERED AGENT CORPORATIONS (Titles 14A and 15A) STATUTORY FEE: $25.00 The MANDATORY review fields are: Business Name List the corporation name as it appears on the records of the Treasurer. Agent Name and Office List the registered agent name and office as they appear on the records of the Treasurer. Declaration of Mailings Add a statement that indicates that copies of the resignation were sent via certified mail, return receipt requested to the last-known president or vice-president and last-known treasurer or secretary. Include the following information for each mailing: certified mail number; post office form which mailing was done; mailing address; and indication of whether the mailing was accepted or not, and if accepted, by whom. If the mailing was not accepted by any party, provide an explanation. Form 104E provides all of the necessary blanks and statements for these filing requirements. Date That Resignation Was Mailed List the mailing date. ATTESTATIONS Add a statement indicating: 1) an understanding that the resignation is effective 30 days after filing of the change form with the Division of Revenue, or upon the designation of a new agent/office by the affected corporation, whichever is earlier; and 2) that the Treasurer is the agent for service of process until a new agent is designated. Form 104E provides the requisite language. ATTACHMENTS Attach a copy of the resignation. EXECUTION The resigning agent must sign. Also, list the date of execution (signature). ********** These documents should be filed in duplicate. Non-profits should file in triplicate. Make checks payable to: TREASURER, STATE Of NEW JERSEY. (No cash, please) Mail to: NJ Division of Revenue, PO Box 308, Trenton, NJ 08646 American LegalNet, Inc. www.USCourtForms.com