Appointment Of Registered Agent Form 2009
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1ROSS MILLER
Secretary of State
204 North Carson Street, Suite 1
Carson City, Nevada 89701-4520
(775) 684 5708
Website:
Appointment of
Registered Agent
by Nonfiling Domestic and Nonqualified Foreign Entities
(PURSUANT TO NRS 77.380)
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
1. Name of Nonfiling or Nonqualified Entity:
2. Entity Type:
3. Jurisdiction of Organization:
4. The above named entity appoints the following agent for service of process in Nevada:
(please complete a, b or c)
a) Commercial Registered Agent:
Name
b) Noncommercial Registered Agent:
Name
Nevada
Street Address
City
Zip Code
Nevada
Mailing Address (if different from street address)
City
Zip Code
c) Title of Office or Other Position with Entity:
Name of Title or Position
Nevada
Street Address
City
Zip Code
Nevada
Mailing Address (if different from street address)
City
Zip Code
5. This statement remains in effect for a period of 5 years after the date of filing unless canceled earlier or terminated
by qualification.
6. Entity Signature:
X
Date
Authorized Signature of Nonfiling or Nonqualifying Entity
7. I hereby accept appointment as Registered Agent for the above named Entity.
X
Authorized Signature of Registered Agent or On Behalf of Registered Agent Entity
Date
Fee: $60.00
Nevada Secretary of State Form RA Misc Appointment
Reset
This form must be accompanied by appropriate fees.
Effective 5-15-09
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