COMMERCIAL REGISTERED AGENT
Secretary of State Office
500 E Capitol Ave
RECEIPT NO ___________________
REGISTRATION
Pierre, SD 57501
(605)773-4845
Please Type or Print Clearly in Ink
Clear Form
Original
Photocopy
Please submit one
and one
FILING FEE: $100
SECRETARY OF STATE
payable to
HELP
CRA NUMBER __________________
The Commercial Registered Agent
Number will be issued by the
Secretary of State.
The undersigned submits the following statement for the purpose of being listed as a
Commercial Registered Agent in the State of South Dakota.
1. The name of the individual or entity __________________________________________________________________
2. If an entity the jurisdiction of organization______________________________________________________________
3. If an entity the type of entity ________________________________________________________________________
4. The street address in South Dakota of the place of business to which service of process may be delivered
______________________________________________________________________________________________
Street Address (Required to be a South Dakota Address)
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional – Required to be a South Dakota Address)
City
State
ZIP+4
5. Optional statement regarding alternate means of accepting service of process
______________________________________________________________________________________________
The following information is not required. Any information provided will be available to the public on the Secretary of
State’s website at
6. Phone number _________________
7. Fax number
_________________
8. E-mail address __________________________________________________________________________________
9. Web address
__________________________________________________________________________________
The above referenced individual or entity intends to be in the business of serving as a Commercial Registered Agent in
the State of South Dakota.
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Commercialagentregistration April 2012