State Form 26285 - Statement Of Resignation Of Registered Agent 2012
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STATEMENT OF RESIGNATION OF
CONNIE LAWSON
REGISTERED AGENT
SECRETARY OF STATE
CORPORATIONS DIVISION
State Form 26285 (R8 / 4-12)
302 W. Washington Street, Room E018
Approved by State Board of Accounts, 1995
Indianapolis, Indiana 46204
Telephone: (317) 232-6576
INSTRUCTIONS:
Use 8 1/2" x 11" white paper for attachments.
Present original and one copy to address in upper right corner of this form.
Indiana Code 23-1-24-3 (for profit corporation)
Please TYPE or PRINT.
Indiana Code 23-17-6-3 (non-profit corporation)
Please visit our office on the web at
NO FILING FEE
REGISTERED AGENT STATEMENT
I, the undersigned, hereby resign the appointment as the registered agent for the following entity:
Name of Entity
REGISTERED OFFICE ADDRESS:
Address (number and street, city, state, and ZIP code)
IN WITNESS WHEREOF , the undersigned being the registered agent of said Entity executes this resignation and verifies, subject
to penalties of perjury, that the statements contained herein are true, this ______ day of ____________________________,
20 _______.
Signature
Printed name
The agency appointment is hereby terminated, and the registered office is discontinued as so provided thirty-one (31) days from
the date of filing of this statement.
OFFICE USE ONLY
The Secretary of State has mailed one copy to the Corporation at its principal office and a copy to the registered office, if not
discontinued.
Signature of Secretary of State
Signature of Deputy
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