J. Kenneth Blackwell
Prescribed by:
J. Kenneth Blackwell
Secretary of State
30 East Broad St. 14th Floor
Columbus, Ohio 43266-0418
ORIGINAL APPOINTMENT OF AGENT
(for limited liability company)
The undersigned, being at least a majority of the members of
,
(name of limited liability company)
hereby appoint
to be the agent upon whom any process, notice or
(name of agent)
demand required or permitted by statute to be served upon the limited liability company may be served. The complete address
of the agent is:
(street address
P.O. Boxes are not acceptable)
, Ohio
(city, village, township)
(zip)
By:
By:
( authorized member, manager, or representative )
( authorized member, manager, or representative )
Name:
Name:
By:
By:
( authorized member, manager, or representative )
( authorized member, manager, or representative )
Name:
Name:
By:
By:
( authorized member, manager, or representative )
( authorized member, manager, or representative )
Name:
Name:
ACCEPTANCE OF APPOINTMENT
The undersigned , named herein as the statutory agent for
(name of limited liability company )
hereby acknowledges and accepts the appointment of agent for said limited liability Company.
(Agent's signature)
115-LCA
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Version: 7/15/99