ROSS MILLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684 5708
Website: secretaryofstate.biz
Resident Agent Acceptance
General instructions for this form:
ABOVE SPACE IS FOR OFFICE USE ONLY
1. Please print legibly or type; Black Ink Only
2. Complete all fields. Do not highlight.
3. Ensure that document is signed in signature field.
In the matter of
(Name of business entity)
I,
(Name of resident agent)
hereby state that on
I accepted the appointment as resident agent
(Date)
for the above named business entity. The street address of the resident agent in this
state is as follows:
(MANDATORY) Physical Street Address
Suite number
NEVADA
City
Zip Code
Optional: (address where mail will be sent)
(OPTIONAL) Additional Mailing Address
Suite number
City
State
Zip Code
Signature:
X
Authorized Signature of R.A. or
On Behalf of R.A. Company
Date
Nevada Secretary of State RA Acceptance 2007
Revised on: 01/01/07
Reset