Application For Certificate Of Authority Foreign Corporation - Connecticut Secretary Of The State - 2010 Page 2
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11. DIRECTORS
NAME
RESIDENCE ADDRESS
BUSINESS ADDRESS
12. Appointment of Registered Agent for Service of Process
(Check A or complete B)
. ________
A
The corporation appoints the Secretary of the State of Connecticut and his successors in
office to be its agent upon whom any process, in any action or proceeding against it, may be served.
B. Print or type name of agent
Business address: (P.O. Box unacceptable)
______________________________________
Residence address: (P.O. Box unacceptable)
Acceptance of Appointment
______________________________________________________________________
Signature of Agent
13. EXECUTION-REQUIRED: (Subject to penalty of false statement.)
Dated this _____ day of _________, 20_________.
Print or type name of signatory
Capacity of signatory
Signature
Rev. 2/22/2010
R:\CommercialRecording\CRD WEB FORMS\docs\app for cert of auth - foreign corp.DOC
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