Application For Certificate Of Authority - Wyoming Secretary Of State, Consent To Appointment By Registered Agent - Wyoming Secretary Of State Page 3

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CONSENT TO APPOINTMENT
BY REGISTERED AGENT
Wyoming Secretary of State
Phone (307) 777-7311/7312
The Capitol Building, Room 110
Fax (307) 777-5339
200 W. 24th Street
E-mail: corporations@state.wy.us
Cheyenne, WY 82002-0020
I, _______________________________________________, voluntarily consent to serve as the
registered agent for ___________________________________________________________________
on the date shown below.
The registered agent certifies that he is: (check one)
(a)
An individual who resides in this state and whose business office is
identical with the registered office;
(b)
A domestic corporation or not-for-profit domestic corporation
whose business office is identical with the registered office; or
(c)
A foreign corporation or not-for-profit foreign corporation autho-
rized to transact business in this state whose business office is iden-
tical with the registered office.
Dated this ____________________ day of _____________________________, _________.
________________________________________________
Signature of Registered Agent
Revised: 9/2003

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