Notice Of Entity Election Template Page 2
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1
2Ed Murray
Wyoming Secretary of State
2020 Carey Avenue, Suite 700
Cheyenne, WY 82002-0020
For Office Use Only
Ph. 307.777.7311
Fax 307.777.5339
Email:
Business@wyo.gov
Notice of Entity Election
Communications Contact Person
In accordance with W.S. 17-28-104(d)
(Print Name of Business Entity)
elects to provide the Wyoming Secretary of State with the name, business address and phone number of a natural
person who is an officer, director, employee or designated agent authorized to be the communications contact person
for this business entity.
1. Name and title of the natural person authorized to be the communications contact person:
Print Name:
Print Title:
2. Business Address:
Print Address:
Print City, State and Zip Code:
3. Daytime Phone Number:
4. I hereby certify that the information provided above is true and correct.
Date:
Signature: __________________________________________
(mm/dd/yyyy)
(Shall be executed by an authorized individual.)
Email:
Print Name:
Title:
Checklist
No Filing Fee
The information listed on this form shall be kept current within 60 days of any change.
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.
CommunicationsContact – Updated October 2015
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