Statement Of Resignation Of Registered Agent Successor Appointed - Wyoming Secretary Of State

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Ed Murray
Wyoming Secretary of State
2020 Carey Avenue, Suite 700
For Office Use Only
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Fax 307.777.5339
Email:
Business@wyo.gov
Statement of Resignation of Registered Agent
Successor Appointed
1. This change affects all entities listed on the attached list.
2. Attached is a Statement of Change of Registered Agent/Office by Entity form ratifying and approving the appointment of the
new registered agent for each entity.
3. The new registered agent is:
4. The new registered office is:
5. The resignation is effective immediately upon filing of this statement with the Wyoming Secretary of State.
I hereby resign my appointment as the Registered Agent for entities listed on the attached list.
Signature: _____________________________________________
Date:
(Shall be executed by the Resigning Registered Agent.)
(mm/dd/yyyy)
Printed Name:
I hereby accept my appointment as Registered Agent for the entities listed on the attached list. 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 New Registered Agent.)
(mm/dd/yyyy)
Print Name:
Contact Person:
Title:
Daytime Phone Number:
Email:
(Email provided will receive filing evidence)
*May list multiple email addresses
Checklist
No Filing Fee
Please submit one originally signed document.
Please review form prior to submitting to the Secretary of State to ensure all areas
have been completed to avoid a delay in the processing of your documents.
RAResignation-Successor – Revised October 2015

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