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Statement Of Resignation Of Registered Agent Successor Appointed - Wyoming Secretary Of State Page 3

5. The mailing address of my business should be changed to reflect the new registered office address. Yes

6. The principal address of my business should be changed to reflect the new registered office address. Yes

7. Once completed the physical address of the registered office and business office of the registered agent will be

identical.

Signature: ______________________________________________

Date:

(Shall be executed by an authorized individual)

(mm/dd/yyyy)

Print Name:

Contact Person:

Title:

Daytime Phone:

Email:

(Email provided will receive filing evidence.)

*May list multiple email addresses

Checklist

No Filing Fee

The Statement must be accompanied by a written consent to appointment executed by the registered agent.

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.

RA-RO ChangeByEntity – Revised October 2015

Statement Of Resignation Of Registered Agent Successor Appointed - Wyoming Secretary Of State Page 3