Form Fpr - Application For Certificate Of Authority, Form F-Stmnt - Statement Of Acceptance Of Appointment - Nm Secretary Of State - 2013 Page 4

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325 Don Gaspar, Suite 300 ∙ Santa Fe, NM 87501
(800) 477-3632 ∙
STATEMENT OF ACCEPTANCE OF APPOINTMENT
BY DESIGNATED INITIAL REGISTERED AGENT
I, _____________________________________________________________________, hereby
acknowledge that the undersigned individual or corporation accepts the appointment as Initial
Registered Agent of_______________________________________________, the corporation which is
named in the annexed Application for Certificate of Authority.
_________________________________________________________
(Sign on this line if the registered agent named in the application is an individual. If this line is signed,
the two lines below do not apply and must be left blank.)
CORPORATION ACTING AS A REGISTERED AGENT ONLY
(If the following lines are used, the signature line above does not apply and must be left blank.)
_________________________________________________________
(If the registered agent named in the application is a corporation, type or print the name of that
corporation here.)
By_______________________________________________________
(An authorized officer of the corporation being appointed as registered agent must sign here.)
Form F-STMNT
(revised 06/13)

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