Form 402 - Entity Information

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402
This space reserved for office use.
Form
(Revised 01/06)
Return in duplicate to:
Secretary of State
P.O. Box 13697
Resignation of Registered
Austin, TX 78711-3697
Agent
512 463-5555
FAX: 512/463-5709
Filing Fee: No fee
The undersigned registered agent, currently listed in the records of the secretary of state as the
registered agent authorized to receive service of process for the entity named below, submits this
notice for the purpose of resigning as registered agent.
Entity Information
The name of the entity for which the undersigned serves as registered agent is:
State the name of the entity as currently shown in the records of the secretary of state.
The file number issued to the filing entity by the secretary of state is:
Statement of Notice
Written notice of the resignation has been given by the undersigned registered agent to the entity at
the address of the entity most recently known by the agent. The address to which the notice was
mailed or delivered is:
Address
City
State
Country
Zip/Postal Code
The date on which the written notice was given to the entity was:
mm/dd/yyyy
Execution
The undersigned signs this document subject to the penalties imposed by law for the submission of a
materially false or fraudulent instrument.
Date:
Signature of resigning registered agent
Print
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Form 402
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