FORM X-9
7/2012
Instructions: Statement must be typewritten or printed in black ink, and must be legible. The statement must be signed by
the registered agent. If the registered agent is an entity, an authorized official must sign. All signatures must be in black ink.
Submit original statement together with the appropriate fee(s).
Execution:
If the registered agent is an individual, the individual must sign.
If the registered agent is a corporation, at least one officer of the corporation must sign.
If the registered agent is a general partnership, at least one general partner must sign.
If the registered agent is a limited liability partnership, at least one general partner must sign.
If the registered agent is a limited partnership, at least one general partner must sign.
If the registered agent is a limited liability limited partnership, at least one general partner must sign.
If the registered agent is a limited liability company, at least one manager of a manger-managed company or at least one
member of a member-managed company must sign.
Line 1. Check the appropriate box that applies to the represented entity.
Line 2. State the full name and the state/country of incorporation/formation or organization of the entity.
Line 3. State the name of the resigning registered agent.
Line 4. State the name and address of the person to which the agent will send notice to the above-named entity.
a. State the name of the person.
b. State the complete address of the person.
The resignation will be effective on the thirty-first day after this statement is filed or when a new registered agent is appointed for
the represented entity in compliance with the Hawaii Revised Statutes, as amended.
The registered agent shall promptly furnish the represented entity with notice through a letter, email, or other written form of its
resignation.
Filing Fees: Filing fee ($25) is not refundable. (200 or less affected entities, the filing fee os $25 each. 201 or more
affected entities, the filing fee is $1 each.)
Make checks payable to DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS. Dishonored Check Fee ($25).
For any questions call (808) 586-2727. Neighbor islands may call the following numbers followed by 6-2727 and the # sign:
Kauai 274-3141; Maui 984-2400; Hawaii 974-4000, Lanai & Molokai 1-800-468-4644 (toll free).
Fax: (808) 586-2733
Email Address:
breg@dcca.hawaii.gov
NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE
DIVISION SECRETARY, BUSINESS REGISTRATION DIVISION, DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST.
ALL BUSINESS REGISTRATION FILINGS ARE OPEN TO PUBLIC INSPECTION. (SECTION 92F-11, HRS)