Public Safety Organization Independent Promoter Public Safety Publication Registration Statement - Texas Secretary Of State Page 3

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13.
If the registering entity is a public safety publication, provide the following information.
(A) The total number of copies of each issue of the publication to be printed is
_________________________________________________________________________.
(B) The frequency of the publication is
_________________________________.
(C) The date and circulation of the most recent issue of the publication is
___________________________________________________________________
___________________________________________________________________.
14.
Is the registrant a resident of Texas?
___________________
If you are not a resident of this state,
attach a written consent form appointing the Secretary of State as agent for service of process on the
Registrant for any action pertaining to a violation of this Act.
Executed this
______________
day of
_
__________________________
,
___________
.
__________________________________________ _______________________________________
(Signature of Officer or Director)
(Signature of Officer or Director)
__________________________________________ _______________________________________
(Printed Name & Title)
(Printed Name & Title)
Print
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INFORMATION AND INSTRUCTIONS
The document must be signed by two officers or directors of the registering entity.
Return the registration/renewal form and $250 filing fee to:
SECRETARY OF STATE
Registrations Unit
P. O. Box 13550
Austin, TX 78711-3550
*******
PLEASE NOTE - A CHANGE IN THE REGISTRANT'S STREET ADDRESS, PHONE
NUMBER, OR NAME MUST BE FILED WITH THE SECRETARY OF STATE'S OFFICE WITHIN 30
DAYS AFTER THE DATE OF THAT CHANGE.

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