Form Fnp - Application For Certificate Of Authority, Form F-Stmnt - Statement Of Acceptance Of Appointment - 2013 Page 3

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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.)
(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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