Form 260.165 - Consent To Service Of Process printable pdf download

TO THE COMMISSIONER OF CORPORATIONS OF

THE STATE OF CALIFORNIA

CONSENT TO SERVICE OF PROCESS

KNOW ALL MEN BY THESE PRESENTS:

That the undersigned, [________________________________________________________________________________________ (a

corporation, partnership or limited liability company organized under the laws of the State of ___________________________),

____________________________________________________ (an individual),

_____________________________________________________ (other entity),]

hereby irrevocably appoints the Commissioner of Corporations of the State of California, or the Commissioner's successor in office, to be the

undersigned's attorney to receive service of any lawful process in any noncriminal suit, action or proceeding against the undersigned, or the

undersigned's successor, executor, or administrator which arises under the Corporate Securities Law of 1968 or any rule or order thereunder after this

consent has been filed, with the same force and validity as if served personally on the undersigned.

For the purpose of compliance with the Corporate Securities Law of 1968 of the State of California, notice of the service and a copy of the

process should be sent by registered or certified mail to the undersigned at the following address:

___________________________________________________________________________________________________________________

(Name and Address)

___________________________________________________________________________________________________________________

Dated: _________________________, _________.

[Insert name of corporation, partnership,

limited liability company or other entity]

By _____________________________

Title ____________________________

[Insert name of individual]

________________________________

State of California

)

County of ________________________)

On __________________________ before me, ____________________________________________________________,

(Name of Notary)

personally appeared ________________________________________________________________________________ (personally

(Here, insert Name and Title of the Officer)

known to me OR proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and

acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the

instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.

Signature ____________________________

(Seal)

Any certificate of acknowledgement taken in another state shall be sufficient in the State of California if it is taken in accordance with the

laws of the place where the acknowledgment is made.

260.165 (Rev. 1/06)

Form 260.165 - Consent To Service Of Process

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