Form Cfd-04 - Appointment Of Agent For Service Of Process By Foreign Bank Or Trust Company

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Arkansas Secre t a ry of State
State Capitol • Little Rock, Arkansas 72201-1094
Charlie Daniels
501-682-3409 •
Appointment of Agent for Service of Process
By Foreign Bank or Trust Company
I,
as President and I,
, as Secretary of the Board of Trustees or Directors
of
, organized under the laws of the State of
, hereby certify that pursuant to Act 947 of 1989, the person or entity
below is hereby designated as Agent for Service of Process upon whom all notices and processes issued by any
court of this State may be served in any action or proceeding relating to said bank, trust, fund, society, association
or insurance company within this State with which the said
is act-
ing in any fiduciary capacity, including any acts, omissions, or defaults with respect to any such bank, trust, fund,
society, association or insurance company.
Name
Street and number
City
State
ZIP
Witness our hands this
day of
,
.
I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State
is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
President
Secretary
Subscribed and sworn to before me, a
, within and for the County
of
, this
day of
,
.
My Commission Expires:
Notary Public
CFD-04 Rev. 4/06

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