Change Of Statutory Agent Form-2007
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1
2CHANGE OF STATUTORY AGENT
DOMESTIC LIMITED LIABILITY COMPANY
Office of the Secretary of the State
MAILING ADDRESS:
DELIVERY ADDRESS:
Commercial Recording Division
Commercial Recording Division
Connecticut Secretary of the State
Connecticut Secretary of the State
P.O. Box 150470
30 Trinity Street
Hartford, CT 06115-0470
Hartford, CT 06106
860-509-6003
860-509-6003
Filing Fee: $25.00
Make Checks Payable To “Secretary of the State”
Space For Office Use Only
1. NAME OF LIMITED LIABILITY COMPANY
2. APPOINTMENT OF NEW STATUTORY AGENT
Business address: (complete address only, P.O.
Box is not acceptable)
Print or type name of agent:
Residence address: (complete address only, P.O.
Box is not acceptable)
Acceptance of appointment
__________________________________________________________
Signature of agent
3. EXECUTION
Dated this _________________day of ____________________, 20_____.
Print or type name of signatory
Capacity of signatory
Signature
REV. 08/23/2007
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