Statutory Trust Certificate Of Trust - Wyoming Secretary Of State, Consent To Appointment By Registered Agent - Wyoming Secretary Of State

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Wyoming Secretary of State
State Capitol Building, Room 110
th
200 West 24
Street
For Office Use Only
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Fax 307.777.5339
Email: business@state.wy.us
Statutory Trust
Certificate of Trust
1. Name of the statutory trust:
2. Name and address of at least one (1) of the trustees authorized to manage the statutory trust:
3. Name and physical address of its registered agent:
(The registered agent may be an individual resident in Wyoming, a domestic corporation, or foreign corporation authorized to transact
business in Wyoming, having a business office identical with such registered office. The registered agent must have a physical address in
Wyoming. A Post Office Box or Drop Box is not acceptable. If the registered office includes a suite number, it must be included in the
registered office address.)
4. Mailing address of the statutory trust:
5. Future effective date or time of this certificate if it is NOT to be effective upon the filing of this certificate:
(Date – mm/dd/yyyy)
Date:
Trustee Signature: _________________________________________
(mm/dd/yyyy)
Print Name:
Date:
Trustee Signature: _________________________________________
(mm/dd/yyyy)
Print Name:
Date:
Trustee Signature: _________________________________________
(mm/dd/yyyy)
Print Name:
Contact Person:
Daytime Phone Number:
Checklist
Filing Fee: $100.00 Make check or money order payable to Wyoming Secretary of State.
The Certificate of Trust must be signed by at least one trustee.
The Certificate of Trust must be accompanied by a written consent to appointment executed by the registered agent.
For consistency the Secretary of State’s Office will only keep one version of the agent’s name on file.
Please submit one originally signed document and one exact photocopy of the filing.
Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in
the processing of your documents.
10
ST-CertificateTrust - Revised 12/2008

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