Form 2605227General Information (Automobile Club Agent Termination Notice) The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant code provisions. This form and the information provided are not substitutes for the advice and services of an attorney. Commentary Automobile Clubs are governed by Chapter 722 of the Texas Transportation Code (the 223Automobile Club Services Act224) and the secretary of state222s administrative rules found in 1 Texas Administrative Code Chapter 75. thAn automobile club must notify the secretary of state no later than the 30 day after the date the automobile club terminates an agent by submitting this form to the secretary of state. Instructions for Form Automobile Club Information: State the name of the automobile club.Agent Information: Include the full legal name, date of birth, last known address, socialsecurity number and gender of the terminated agent.Execution: An authorized representative for the automobile club must sign the form. Delivery Instructions: The form may be mailed to Registrations Unit, P.O. Box 13, Austin,Texas 78711-3 or delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin,Texas 78701.Revised 0/201 Form 2605 1Form 2605 1 American LegalNet, Inc. www.FormsWorkFlow.com This space reserved for office use AUTOMOBILE CLUB AGENT TERMINATION NOTICE Form #2605 Rev. 0/201 Submit to: SECRETARY OF STATE Registrations Unit P O Box 13 Austin, TX 78711-3512-475-0775512-475-2815 - FaxFiling Fee: NoneRegistration Number: Automobile Club Information Name:Agent Information Name: Date of Birth:Last Known Address: StreetCityStateZipSocial Security Number: - - Gender: Male FemaleExecution Date:Signature of authorized person FOR AUTOMOBILE CLUB Printed or Typed NameForm 2605 2 American LegalNet, Inc. www.FormsWorkFlow.com