Statutory Trust Certificate Of Trust, Consent To Appointment By Registered Agent Form - Wyoming Secretary Of State Page 4

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Ed Murray
Wyoming Secretary of State
2020 Carey Avenue, Suite 700
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Fax 307.777.5339
Email:
Business@wyo.gov
Consent to Appointment by Registered Agent
I,
, registered office located at
(name of registered agent)
voluntarily consent to serve
*
(registered office physical address, city, state & zip)
as the registered agent for
(name of business entity)
I hereby certify that I am in compliance with the requirements of W.S. 17-28-101 through W.S. 17-28-111.
Signature:__________________________________________
Date:
(Shall be executed by the registered agent.)
(mm/dd/yyyy)
Print Name:
Daytime Phone:
Title:
Email:
Registered Agent Mailing Address
(if different than above):
*If this is a current registered agent changing their registered address on file, complete the following:
Previous Registered Office(s):
I hereby certify that:
•
After the changes are made, the street address of my registered office and business office will be identical.
•
This change affects every entity served by me and I have notified each entity of the registered office change.
•
I certify that the above information is correct and I am in compliance with the requirements of W.S. 17-28-101 through
W.S. 17-28-111.
Signature: __________________________________________
Date:
(Shall be executed by the registered agent.)
(mm/dd/yyyy)
RAConsent – Revised October 2015

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