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ROSS MILLER
*180303*
Secretary of State
202 North Carson Street
*180303*
Carson City, Nevada 89701-4201
(775) 684-5708
Website:
Registered Agent
Acceptance
(PURSUANT TO NRS 77.310)
This form may be submitted by: a Commercial Registered Agent,
Noncommercial Registered Agent or Represented Entity. For more
information please visit
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
Certificate of Acceptance of Appointment by Registered Agent
In the matter of
Name of Represented Business Entity
I,
am a:
Name of Appointed Registered Agent OR Represented Entity Serving as Own Agent*
(complete only one)
a)
commercial registered agent listed with the Nevada Secretary of State,
b)
noncommercial registered agent with the following address for service of process:
Nevada
Street Address
City
Zip Code
Nevada
Mailing Address (if different from street address)
City
Zip Code
c)
represented entity accepting own service of process at the following address:
Title of Office or Position of Person in Represented Entity
Nevada
Street Address
City
Zip Code
Nevada
Mailing Address (if different from street address)
City
Zip Code
and hereby state that on
I accepted the appointment as registered agent for
Date
the above named business entity.
X
Date
Authorized Signature of R.A. or On Behalf of R.A. Company
*If changing Registered Agent when reinstating, officer's signature required.
X
Date
Signature of Officer
Nevada Secretary of State Form RA Acceptance
Revised: 5-7-13
Reset

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