Change Of Registered Agent - Domestic Stock Or Non-Stock Corporations Form
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1CHANGE OF REGISTERED AGENT
DOMESTIC STOCK OR NON-STOCK CORPORATIONS
Office of the Secretary of the State
30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-0470 / Rev. 1211999
Please see reverse for instruction
Space For Of&e Use Only
, NAME OF CORPORATION:
, APPOINTMENT
OF NEW REGISTERED AGENT: please select onlv one A. or B.)
Print or type name of new agent:
A. Individual’s
Name:
B. Business Entity:
Business address: (P.O. Box is unacceptable)
Residence address: (P.O. Box is unacceptable)
Address: (P-0. Box is unacceptable)
Acceptance of appointment
Signature of agent
4. EXECUTION:
Dated this
day of
920
-
Print or type name of signatory
Capacity of signatory
Signature
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