Form Rmp-14 - Designation And Appointment Of Agent
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Illinois Department of Revenue
RMP-14
Designation and Appointment of Agent
Note:
If you need additional information you may contact us weekdays between 8:00 a.m. and 4:30 p.m. at 217 782-2291.
Step 1: Complete the designation information
1
Appointed Agent’s Name _____________________________________________________________________________
2
Mailing address: ____________________________________________________________________________________
Number and street (required)
IL
__________________________________________________________________________________________________
City
State
Zip
Step 2: Sign below (Licensee)
______________________________________________ is hereby designated as Agent to accept service of legal
Appointed Agent (as identifi ed in Step 1, Line 1)
process directed for service upon the undersigned as well as Agent to accept legal notices of all character.
______________________________________________
_____________________________________
Licensee (Owner or Business name)
License number (if known)
______________________________________________
Name of Owner, partner or authorized offi cer of Licensee (please print))
______________________________________________
____ ____ / ____ ____ / ____ ____ ____ ____
Signature (Owner, partner or authorized offi cer of Licensee)
Date
Step 3: Provide Acceptance Signature (Agent)
I, ____________________________________________, hereby accept appointment as Agent for the purpose of
Appointed Agent (as identifi ed in Step 1, Line1)
accepting legal notices of all character within the State of Illinois for __________________________________
Licensee (as identifi ed in Step 2.)
______________________________________________
____ ____ / ____ ____ / ____ ____ ____ ____
Appointed Agent’s Signature
Date signed
____ ____ / ____ ____ / ____ ____ ____ ____
Appointment effective date
Step 4: Mail Form RMP-14 to:
Reset
Print
ILLINOIS DEPARTMENT OF REVENUE
MOTOR FUEL TAX
PO BOX 19477
SPRINGFIELD IL 62794-9477
RMP-14 (R-02/11)
IL-492-1520
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Parent category: Financial