Form Ra-100 - Resignation Of Agent Upon Whom Process May Be Served - State Of California Secretary Of State

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State of California
Kevin Shelley
Secretary of State
RESIGNATION OF AGENT
UPON WHOM PROCESS MAY BE SERVED
(Corporations Code section 1503, 6211, 8211, 9660, 15627 or 17061)
There is no fee for filing this form.
IMPORTANT - Read instructions on reverse before completing this form.
This Space For Filing Use Only
1.
(
):
ENTITY TYPE
CHOOSE ONLY ONE
CORPORATION
LIMITED PARTNERSHIP
LIMITED LIABILITY COMPANY
2.
:
ENTITY NUMBER
3.
:
ENTITY NAME
4.
:
STATE OR COUNTRY OF ORGANIZATION
5.
PLEASE TAKE NOTICE THAT THE UNDERSIGNED HEREBY RESIGNS AS AGENT UPON WHOM PROCESS
-
.
MAY BE SERVED IN CALIFORNIA FOR THE ABOVE
REFERENCED ENTITY
6.
,
I DECLARE THAT I AM THE PERSON WHO EXECUTED THIS INSTRUMENT
WHICH EXECUTION IS MY ACT
.
AND DEED
(
.
)
(
.
)
A
DATE
B
SIGNATURE OF RESIGNING AGENT
(
.
)
C
TYPE OR PRINT NAME OF RESIGNING AGENT
RA-100 (REV 03/2004)
APPROVED BY SECRETARY OF STATE
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