1.
2.
3.
4.
5.
INSTRUCTIONS
FOR COMPLETION
OF THE CHANGE
OF AGENT FORM
Foreign Limited Liability
Company
Instructions correspond with numbered entries on the form
NAME OF LIMITED LIABILITY
COMPANY IN STATE OR COUNTRY OF
FORMATION:
Please provide the complete name of the limited liability company.
THE NAME UNDER WHICH LIMITED LIABILITY
COMPANY
SHALL
TRANSACT
BUSINESS IN CONNECTICUT:
Provide the complete name under which
the limited liability company transacts business in Connecticut as it currently appears on
the records of the Secretary of the State if other than the name stated in item number 1.
STATE/COUNTRY
OF FORMATION:
Please provide the limited liability company’s
state or country of formation.
APPOINTMENT
OF NEW STATUTORY
AGENT:
A LIMITED
LIABILITY
COMPANY
MAY NOT BE ITS OWN AGENT. The limited liability company may
appoint either the Secretary of the State by placing a check next to selection A or a natural
person who is a resident of Connecticut, a Connecticut corporation, a foreign corporation
which has obtained a certificate of authority to transact business in Connecticut, a
Connecticut limited liability company or a foreign limited liability company which is
registered to transact business in this state by completing selection B. If the agent is a
natural person, such person must provide the complete street address of his or her
business and residence. If the agent is a corporation or limited liability company, it must
provide the address of its principal office in the block provided for “Business address”
and the person signing on its behalf must include his or her title on the signature line.
The agent must sign accepting the appointment.
EXECUTION:
The document must be executed by an authorized official of the limited
liability company. That person must print or type their name, state the capacity under
which they sign and provide an original signature. The execution constitutes a legal
statement under the penalties of false statement that the information provided in the
document is true.