Notice Of Issuance Of Shares Form - California Commissioner Of Corporations (Page 4 of 4) in pdf

Notice Of Issuance Of Shares Form - California Commissioner Of Corporations Page 4

TO THE COMMISSIONER OF CORPORATIONS OF

THE STATE OF CALIFORNIA

CONSENT TO SERVICE OF PROCESS

KNOW ALL MEN BY THESE PRESENTS:

That the undersigned, ___________________________ (a corporation organized under

the laws of the State of __________), hereby irrevocably appoints the Commissioner of

Corporations of the State of California, or the Commissioner's successor in office, to be the

attorney to receive service of any lawful process in any noncriminal suit, action or proceeding

against it, or its successor which arises under the California Corporate Securities Law of 1968 or

any rule or order thereunder after this consent has been filed, with the same force and validity as

if served personally on the undersigned.

For the purpose of compliance with the Corporations Code of the State of California,

notice of the service and a copy of the process should be sent by registered or certified mail to the

undersigned at the following address:

_________________________________________________________________

Name

_________________________________________________________________

Street Address

_________________________________________________________________

City

State

Zip Code

Dated: ____________________, _____.

___________________________________

By ________________________________

Title _____________________________

State of California

)

County of ______________ )

On ______________ before me, (here insert name and title of the officer), personally appeared

____________________________ personally known to me (or proved to me on the basis of

satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and

acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and

that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the

person(s) acted, executed the instrument.

WITNESS my hand and official seal.

Signature_______________________________

(Seal)

Any certificate of acknowledgement taken in another state shall be sufficient in the State of California if it is taken in

accordance with the laws of the place where the acknowledgement is made.

Notice Of Issuance Of Shares Form - California Commissioner Of Corporations Page 4