Form Ss-4512 - Agent Appointment By Nonresident Fiduciary printable pdf download

Form Ss-4512 - Agent Appointment By Nonresident Fiduciary

AGENT APPOINTMENT BY NONRESIDENT FIDUCIARY

(SS-4512)

For Office Use Only

Business Services Division

Tre Hargett, Secretary of State

State of Tennessee

312 Rosa L. Parks Ave., 6th Fl.

Nashville, TN 37243

(615) 741-2286

Filing Fee $10.00

The undersigned, a nonresident person, bank or trust company, wishing to act as a fiduciary in the State of

Tennessee in conformity with the laws thereof, hereby appoints the Secretary of State of the State of Tennessee

as the undersigned’s agent for service of process pursuant to T.C.A. § 35-50-107.

All process in any suit or proceeding against the undersigned may be served upon the Tennessee Secretary

of State in any action or proceeding relating to any trust, estate or matter within this State in respect of which

the undersigned is acting in a fiduciary capacity.

The undersigned agrees that any process against the undersigned, which is served upon the Tennessee

Secretary of State, shall be of the same legal force and validity as if served on the undersigned.

It is understood that this appointment shall continue for as long as any liability shall remain outstanding against

the undersigned pertaining to any such matters.

1. The specific trust, estate or person for which the undersigned has been appointed as fiduciary is:

The street address (including zip code) of the undersigned (to which all copies of legal process should be

addressed) is:

Address:

City:

State:

Zip Code:

Note: Pursuant to T.C.A. § 10-7-503, all information on this form is public record.

Executed this ______ day of

, 20 ___.

Name

(Printed or Typed)

Signature

(Rev: 6/13)

RDA 1764

Form Ss-4512 - Agent Appointment By Nonresident Fiduciary