Statement Appointing An Agent Form - State Of Texas
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1Office of the Secretary of State
Corporations Section
P.O. Box 13697
Austin, Texas 78711-3697
STATEMENT APPOINTING AN AGENT
The undersigned entity, pursuant to applicable law, hereby appoints an agent authorized to
receive service of process and provides the following information:
1.
The undersigned entity is: (Check one)
a Texas financial institution, filing pursuant to section 201.103, Finance Code;
an unincorporated nonprofit association, filing pursuant to section 12(f),
Texas Uniform Unincorporated Nonprofit Association Act; or
a defense base development authority, filing pursuant to section 378.004(b),
Local Government Code.
2.
The name of such entity is
3.
A.
The federal tax identification number of the entity is
B.
The entity does not have a federal tax identification number at this time. Upon
receipt of its federal tax identification number, the entity will notify the
secretary of state of its number. (Check 3B if applicable.)
4.
The address, including the street address, of the principal office of the entity is
5.
The name of the person authorized to receive service of process on behalf of the entity
is
and that person's street address in Texas is
6.
As evidenced by the signature below, the person appointed as agent to receive service
of process accepts the appointment made by the undersigned entity.
Name of the entity
By
Signature of Authorized Officer
Appointment as Agent Accepted
By
Agent for Service of Process
Date:
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