Form 11 F0010 - Registered Agent/office Statement Of Change
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111 F0010
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P O BOX 136, JACKSON, MS 39205-0136 (601)359-1633
Registered Agent/Office Statement of Change
1.
Company Name
corporation
nonprofit
limited liability company
limited partnership
limited liability partnership
foreign business trust
domestic
foreign
2.
Name of the Current Registered Agent and Registered Office (as on file with the Secretary of State)
Name
3.
New Registered Agent’s Name and Registered Office
Name
Physical
Address
P.O. Box
City, State, Zip5, Zip4\\
4.
The undersigned certifies that: 1) he/she has notified the above-named registered agent of this appointment; 2)
he/she has provided the agent an address for the company, and; 3) the agent has agreed to serve as registered agent for this
company.
By:
Signature
Printed name
Title
Mail completed form with the $10 fee to SECRETARY OF STATE, PO BOX 136, JACKSON, MS 39205-0136. For
assistance contact a customer service representative at (800) 256-3494. Visit our website at
for forms and
instructions.
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