Form F0121 - Registered Agent Or Office Statement Of Change
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2F0121 - Page 1 of 2
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136
(601) 359-1333
*0121-1-2*
Registered Agent/Office Statement of Change
1. Limited Liability Company ID
2. Limited Liability Company Name
3. Federal Tax No.
4. Name and Street Address of the Registered Agent and Registered Office is
Name
Physical
Address
P.O. Box
-
City, State, ZIP5, ZIP4
6. New Registered Agent Name
7. If agent has changed, mark appropriate box
7A. The undersigned hereby accepts designation as registered agent for service of process
Signature of Registered Agent
(Please keep writing within block)
OR
7B. Statement of written consent is attached, signed by the new registered agent
8. New street address of registered office
Rev. 01/96
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Parent category: Legal