Application For Certificate Of Authority Foreign Corporation Page 2
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1
2Space for Office Use Only
11. DIRECTORS
NAME
RESIDENCE ADDRESS
BUSINESS ADDRESS
12. Appointment
of Registered Agent for Service of Process
(Check A or complete B.)
A.
The corporation
appoints the Secretary of the State of Connecticut and his successors in
)ffce to be its agent upon whom any process, in any action or proceeding against it, may be served.
B.
Print or type name of agent
Business address: (P.O. Box unacceptable)
Residence address: (P.O. Box unacceptable)
Acceptance of Appointment
Signature of Agent
Dated this
13. EXECUTION
day of
,
20
.
Print or type name of signatory
Capacity of signatory
Signature
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