Form Ctp-129 - Application For Cigarette And Tobacco Products Permits/registration (Page 5 of 8) in pdf

Form Ctp-129 - Application For Cigarette And Tobacco Products Permits/registration Page 5

Appointment of Department of Financial Institutions

for Service of Process

by Nonresident or Foreign Corporation

Section 139.34(9), Wis. Stats.

, an applicant for a Wisconsin cigarette and/or

(Legal Name of Nonresident Individual, Partnership, Limited Liability Company, or Corporation)

tobacco products permit and a nonresident individual, partnership, limited liability company, or corporation

formed under the laws of the State of

appoints the Wisconsin Department of

Financial Institutions for the service of all summons, notices, pleadings, and processes in any actions brought

in the State of Wisconsin and agrees that such service on the Department of Financial Institutions shall have

the same effect as if served on the applicant personally. The appointment shall continue as long as any liability

remains against the applicant in the State of Wisconsin.

Indicate below the address to which any papers served under this appointment should be mailed:

ATTESTING SIGNATURES:

Dated this

Day

Month

Year

Individual, Partner, Member, or Corporate Officer

Title

Individual, Partner, Member, or Corporate Officer

Title

This appointment must be signed by the individual, two members of a partnership or limited liability company

(unless there is only one member of the limited liability company), or two officers of the corporation.

Send the completed form (in duplicate) to: Excise Tax Section 6-107

Wisconsin Department of Revenue

PO Box 8900

Madison WI 53708-8900

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Form Ctp-129 - Application For Cigarette And Tobacco Products Permits/registration Page 5