Form Ar: 0011 - Corporation Or Limited Liability Company (Llc) Statement Of Resignation Of Statutory Agent - Arizona Corporation Commission

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CORPORATION OR LIMITED LIABILITY COMPANY (LLC)
STATEMENT OF RESIGNATION OF
CORPORATION - $10.00
STATUTORY AGENT
LLC - NO FEE
Pursuant to A.R.S. §§10-503(A) & 29-605
_______________________________________________
______________________
(Name of Corporation or LLC)
(ACC file number)
NOTE: It is critical that the Arizona Corporation Commission (ACC) receive the exact name and file
number of the corporation or llc. Please check with our Customer Phone Bank, (602) 542-3026 or our web
site, to obtain the correct information.
IMPORTANT! YOU MUST COMPLETE THE ENTIRE FORM.
1) The undersigned statutory agent of:
_______________________________________________________________________,
(Name of Corporation or LLC)
 an Arizona Corporation, hereby resigns from my appointment as agent.
 a foreign corporation qualified to do business in Arizona, hereby resigns from my
appointment as agent.
 an Arizona LLC, hereby resigns from my appointment as agent.
 a foreign LLC qualified to do business in Arizona, hereby resigns from my appointment
as agent.
2)  The known place of business, currently the street address of the undersigned, is also
discontinued (please check box if this applies).
3) The undersigned has given notice of this resignation (required by A.R.S. §10-503(A) and §29-
605) to the entity by mailing one copy to the Corporation or LLC at the following address:
________________________________________________________________
________________________________________________________________
This resignation shall be effective on the thirty-first day after the date on which this statement
is delivered to the Arizona Corporation Commission for filing.
Dated this _______ day of ________________________, __________
Signature: _______________________________________________
Printed Name: __________________________Title: ________________
________________________________________________________
If signing on behalf of a company serving as statutory agent, print company name here
This form must be delivered to:
ARIZONA CORPORATION COMMISSION
Corporations Division
1300 West Washington
Phoenix, Arizona 85007-2929
AR: 0011
Arizona Corporation Commission
Rev: 10/2009
Corporations Division

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