Form 6 - Consent To Service Of Process printable pdf download

Form 6 - Consent To Service Of Process

SECURITIES AND BUSINESS REGULATION

237 Coliseum Drive

Macon, Georgia 31217-3858

(404) 656-3920

CONSENT TO SERVICE OF PROCESS

KNOW ALL PERSONS BY THESE PRESENTS:

That the undersigned,

________________________________________________________________________________________

Circle One:

A. A corporation organized under the laws of the State of:

(Corporate Resolution or Form U2A is required)

A limited liability company organized under the laws of the State of:

A limited partnership organized under the laws of the State of:

D. An individual

Other

for the purpose of complying with the laws of the State of Georgia relating to either the registration or sale of securities, hereby

irrevocably appoints the Commissioner of Securities, and the successors in such office, its attorney in the State of Georgia upon whom may

be served any notice, process or pleading in any action or proceeding against it arising out of or in connection with the sale of

securities or out of violation of the aforesaid laws of said State. The undersigned does hereby consent that any such action or

proceeding against it may be commenced in any court of competent jurisdiction and proper venue within said State by service of

process upon said officer with the same effect as if the undersigned was organized or created under the laws of said State and had

lawfully been served with process in said State.

It is requested that a copy of any notice, process or pleading served hereunder be mailed to:

Name:

Address:

City/State/Zip:

Email:

This ______________________________ day of _____________, 20____

Applicant: ______________________________________________________

By: ____________________________________________________________

(SEAL)

Print Name and Title: ______________________________________________

Attest (Authorized Signature): ________________________________________

Print Name and Title: _______________________________________________

Form 6 Rev. 06/2010

Form 6 - Consent To Service Of Process