Statement Of Resignation Of Registered Agent Form - 2012
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1STATEMENT OF RESIGNATION
Secretary of State Office
500 E Capitol Ave
OF REGISTERED AGENT
Pierre, SD 57501
Clear Form
(605)773-4845
For use by Noncommercial or
Commercial Registered Agent
HELP
Please Type or Print Clearly in Ink
Original
Photocopy
Please submit one
and one
NO FILING FEE
Telephone # ____________________
FAX #
_______________________
The registered agent identified below submits to the Secretary of State the following statement of
resignation. The statement of resignation takes effect on the thirty-first day after the day on which it is
filed with the Secretary of State office or upon appointment of a new registered agent which ever
occurs first.
1. The name of the entity is _________________________________________________________________________
______________________________________________________________________________________________
2. The name of the registered agent ___________________________________________________________________
3. The name and address of the person to which the agent will send notice to at the represented entity
_______________________________________________________________________________________________
Person Receiving Notice
Street Address
City
State
ZIP+4
4. The agent resigns from serving as the agent for service of process for the above stated entity.
The statement of resignation shall be signed by or on behalf of the agent.
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Registeredagentresignation April 2012
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