Form 521 - Filing Form Cover Letter Page 3
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7Form 521 Prescribed by:
Statutory Agent Update
Filing Fee: $25
(CHECK ONLY ONE(1) BOX)
(1) Subsequent Appointment of Agent
(2) Change of Address of an Agent
(3) Resignation of Agent
Corp
)
(155-AGR
Corp
Corp
(165-AGS)
(145-AGA)
LP
(155-AGR)
LP
LP
(165-AGS)
(145-AGA)
LLC
(153-LAG)
LLC
LLC
(171-LSA)
(144-LAD)
Partnership
(153-LAG)
Business Trust
Business Trust
Business Trust
(171-LSA)
(144-LAD)
(153-LAG)
Real Estate Investment Trust
Real Estate Investment Trust
Real Estate Investment Trust
(171-LSA)
(144-LAD)
(153-LAG)
Name of Entity
Charter, License or Registration No.
Name of Current Agent
Complete the information in this section if box (1) is checked
Name and Address
of New Agent
Name of Agent
Mailing Address
City
State
ZIP Code
Form 521
Last Revised: 05/14/2014
Page 3 of 7
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