Free OFFICE OF THE SECRETARY OF STATE - Texas

Form 2605--General Information (Automobile Club Agent Termination Notice)
The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant code provisions. This form and the information provided are not substitutes for the advice and services of an attorney.

Commentary Automobile Clubs are governed by Chapter 722 of the Texas Transportation Code (the "Automobile Club Services Act") and the secretary of state's administrative rules found in 1 Texas Administrative Code Chapter 75. An automobile club must notify the secretary of state no later than the 30th day after the date the automobile club terminates an agent by submitting this form to the secretary of state. Instructions for Form · · · · Automobile Club Information: State the name of the automobile club. Agent Information: Include the full legal name, date of birth, last known address, social security number and gender of the terminated agent. Execution: An authorized representative for the automobile club must sign the form. Delivery Instructions: The form may be mailed to P.O. Box 13550, Austin, Texas 78711-3550 or delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701.

Revised 03/09

Form 2605

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Form #2605

Rev. 03/2009

This space reserved for office use

Submit to: SECRETARY OF STATE Statutory Documents Section P O Box 13550 Austin, TX 78711-3550 512-475-1769 512-475-2815 - Fax Filing Fee: None

AUTOMOBILE CLUB AGENT TERMINATION NOTICE

Registration Number:

Automobile Club Information
Name:

Agent Information
Name: Last Known Address:
Street City State Zip

Date of Birth:

Social Security Number:

-

-

Gender:

Male

Female

Execution
Date:
Signature of authorized person FOR AUTOMOBILE CLUB Printed or Typed Name

Print

Reset

Form 2605

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