Fillable Form M002.001 - Statutory Agent Acceptance

Form M002.001 - Statutory Agent Acceptance - 2010

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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.

STATUTORY AGENT ACCEPTANCE

Please read Instructions

M002i

ENTITY NAME – give the exact name in Arizona of the corporation or LLC that has appointed the

Statutory Agent:

_______________________________________________________________________

A.C.C. FILE NUMBER (

):__________________________

if entity is already incorporated or registered in AZ

Find the A.C.C. file number on the upper corner of filed documents OR on our website at:

STATUTORY AGENT NAME – give the exact name of the Statutory Agent appointed by the

entity listed in number 1 above (this will be either an individual or an entity):

_____________________________________________________________________________

3.1

Check one box:

The statutory agent is an Individual (natural person).

The statutory agent is an Entity.

STATUTORY AGENT SIGNATURE:

By the signature appearing below, the individual or entity named in number 3 above

accepts the appointment as statutory agent for the entity named in number 1 above, and

acknowledges that the appointment is effective until the entity replaces the statutory agent or

the statutory agent resigns, whichever occurs first.

By checking the box marked "I accept" below, I acknowledge under penalty of perjury that this

document together with any attachments is submitted in compliance with Arizona law.

I ACCEPT

Signature

Printed Name

Date

REQUIRED – check only one:

Individual as statutory agent: I am

Entity as statutory agent: I am signing on

signing on behalf of myself as the individual

behalf of the entity named as statutory agent,

and I am authorized to act for that entity.

Filing Fee: none (regular processing)

Mail:

Arizona Corporation Commission - Corporate Filings Section

Expedited processing – add $35.00 to filing fee.

1300 W. Washington St., Phoenix, Arizona 85007

All fees are nonrefundable - see Instructions.

Fax:

602-542-4100

Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain

to the individual needs of your business.

All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.

If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.

M002.001

Arizona Corporation Commission – Corporations Division

Rev: 2010

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