Resident Agent Acceptance - Nevada Secretary Of State
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1DEAN HELLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(
775) 684 5708
Website: secretaryofstate.biz
Resident Agent Acceptance
General instructions for this form:
ABOVE SPACE IS FOR OFFICE USE ONLY
1. Please print legibly or type; Black Ink Only.
2. Complete all fields.
3. Ensure that document is signed in signature field.
In the matter of
(Name of business entity)
I, _____________________________________________________________________,
(Name of resident agent)
hereby state that on
I accepted the appointment as resident agent
(Date)
for the above named business entity. The street address of the resident agent in this
state is as follows:
Physical Street Address
Suite number
, NEVADA
City
Zip Code
Optional:
Additional Mailing Address
Suite number
,
City
State
Zip Code
Signature:
Authorized Signature of R.A.
or
On Behalf of R.A. Company
Date
Nevada Secretary of State RA Acceptance 2003
Revised on: 11/04/03
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