STATE OF HAWAII
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
Business Registration Division
1010 Richards Street
Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810
STATEMENT OF RESIGNATION OF REGISTERED AGENT, DOMESTIC CORPORATION
(Section 415-12, 415B-8.7, Hawaii Revised Statutes)
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK
The undersigned, registered agent for a domestic corporation incorporated in the State of Hawaii, certifies as follows:
The corporation is (check one):
The name of the corporation is:
I am the current registered agent for the corporation. My name is:
The registered office of the corporation is (check one):
remains the same.
The address of the corporation’s registered office is:
A copy of this statement has been mailed to the above-named corporation at its principal office and to the corporation’s
registered office, if not discontinued.
Notice is hereby given that I am resigning as the registered agent, to be effective on the thirty-first day after the filing of this
statement in the office of the Director of Department of Commerce and Consumer Affairs.
I certify under the penalties of Section 415-136, 415B-158, Hawaii Revised Statutes, as applicable, that I have read the above
statements and that the same are true and correct.
Signed this ____________day of ___________________________________, __________
(Type/Print Name of Agent)
SEE INSTRUCTIONS ON REVERSE SIDE. The statement must be signed by the registered agent. If registered agent is a
corporation, an authorized officer must sign.