Registered Agent/change Of Registered Agent/registered Office - Alabama Department Of Revenue

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LABAMA
EPARTMENT OF
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P.O. Box 327555 • Montgomery, AL 36132-7555 • (334) 242-9627
Registered Agent/Change of Registered Agent/Registered Office
MAIL TO: Alabama Department of Revenue
Tobacco Tax Section
P.O. Box 327555
Montgomery, AL 36132-7555
For the purpose of having and continuously maintaining a registered agent at a registered office within the State of
Alabama, the undersigned submits the following statements of fact:
1. The exact name of the entity: ______________________________________________________________________
Appointed/Newly Appointed Registered Agent Information
2. The name of the appointed/newly appointed registered agent: ______________________________________
3. The street and mailing address of the appointed/newly appointed registered office (must be in Alabama):
___________________________________________________________________________________________
___________________________________________________________________________________________
(Include street name and number or physical location in addition to box number with the city and zip)
Signature of consent of new agent (required if new or changed): _______________________________________ _ __
4. The name of the former registered agent: ____________________________________________________________
5. The street and mailing address of the former registered office:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
(Include street name and number or physical location in addition to box number with the city and zip)
6. The undersigned further states that the street address of its registered office and the address of the business office of
its registered agent, as changed, will be identical.
7. By my signature, I, as an official of the above corporation, do state that I signed this statement on behalf of the corpo-
ration and that the statements contained therein are true, under penalty of law.
____________________________________________________________________
___________________________
Signature of Officer or Authorized Person
Date
____________________________________________________________________
Printed Name and Title of above Authorized Person

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