The consent to service of process (Form
U-2, Uniform Consent to Service of
Process, or Form 260.165; 10 C.C.R. Sec. 260.165) is
[ ] attached or [ ]
already on file with the Commissioner of Corporations.
Date of Notice: __________________________
__________________________________________
(Issuer)
__________________________________________
(Authorized Signature on Behalf of Issuer)
__________________________________________
(Print Name of Signatory)
__________________________________________
(Print Title of Signatory)