APPLICATION FOR REGISTRATION
FOREIGN STATUTORY TRUST
MAILING ADDRESS: Commercial Recording Division Connecticut Secretary of the State P.O. Box 150470 Hartford, CT 06115-0470 860-509-6003
Office of the Secretary of the State
DELIVERY ADDRESS: Commercial Recording Division Connecticut Secretary of the State 30 Trinity Street Hartford, CT 06106 860-509-6003
Space For Office Use Only
Filing Fee: $60.00
Make Checks Payable To "Secretary of the State"
1. NAME OF STATUTORY TRUST IN ITS STATE OR COUNTRY OF FORMATION:
2. IF DIFFERENT FROM THE NAME STATED ABOVE, THE NAME UNDER WHICH THE STATUTORY TRUST SHALL TRANSACT BUSINESS IN CONNECTICUT:
3. STATE/COUNTRY OF FORMATION: _____________________________________
4. DATE OF FORMATION:
_______/_______/_________ Month Day Year 5. ADDRESS OF THE OFFICE REQUIRED TO BE MAINTAINED IN THE JURISDICTION OF FORMATION OR, IF NOT REQUIRED, THE ADDRESS OF THE STATUTORY TRUST'S PRINCIPAL OFFICE (P.O. Box not acceptable):
________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ _______________________________________________________________________________________
6. THE CHARACTER OF BUSINESS WHICH THE STATUTORY TRUST TRANSACTS OR INTENDS TO TRANSACT IN CONNECTICUT:
7. THIS IS A FOREIGN STATUTORY TRUST, WHICH IS NOT ORGANIZED UNDER THE LAWS OF THIS STATE. 8. DATE STATUTORY TRUST BEGAN TRANSACTING BUSINESS IN CONNECTICUT: _______/_______/________ Month Day Year
Note: If additional space is needed, please reference an 8 1/2 X 11 attachment
REV. 08/24/2007
Space for Office Use Only
9. Appointment of Agent for Service of Process (Check A or complete B.)
A. _________
The statutory trust appoints the Secretary of the State of Connecticut and his successors in office to be its agent upon whom any process, in any action or proceeding against it, may be served.
B. _________
The statutory trust appoints the following Connecticut resident; domestic corporation; limited liability company; registered limited liability partnership; or statutory trust or foreign authorized/registered corporation; limited liability company; registered limited liability partnership; or statutory trust to be its agent upon whom any process, in any action or proceeding against it, may be served. Business address: (P.O. Box is unacceptable)
Print or type name of agent ______________________________________
Residence address: (P.O. Box unacceptable)
Acceptance of Appointment ______________________________________________________________________ Signature of Agent
10. Execution-REQUIRED: (Subject to penalty of false statement.)
Dated this _____ day of _________, 20______.
Print or type name of signatory
Capacity of signatory
Signature
REV. 08/24/2007