Free Certificate of Trust - Wyoming

Wyoming Secretary of State
State Capitol Building, Room 110 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: [email protected]

For Office Use Only

Statutory Trust Certificate of Trust
1. Name of the statutory trust:

2. Name and address of at least one (1) of the trustees authorized to manage the statutory trust:

3. Name and physical address of its registered agent:
(The registered agent may be an individual resident in Wyoming, a domestic corporation, or foreign corporation authorized to transact business in Wyoming, having a business office identical with such registered office. The registered agent must have a physical address in Wyoming. A Post Office Box or Drop Box is not acceptable. If the registered office includes a suite number, it must be included in the registered office address.)

4. Mailing address of the statutory trust:

5. Future effective date or time of this certificate if it is NOT to be effective upon the filing of this certificate:
(Date ­ mm/dd/yyyy)

Date:
(mm/dd/yyyy)

Trustee Signature: _________________________________________ Print Name:

Date:
(mm/dd/yyyy)

Trustee Signature: _________________________________________ Print Name:

Date:
(mm/dd/yyyy)

Trustee Signature: _________________________________________ Print Name:

Contact Person: Daytime Phone Number:
Checklist Filing Fee: $100.00 Make check or money order payable to Wyoming Secretary of State. The Certificate of Trust must be signed by at least one trustee. The Certificate of Trust must be accompanied by a written consent to appointment executed by the registered agent. For consistency the Secretary of State's Office will only keep one version of the agent's name on file. Please submit one originally signed document and one exact photocopy of the filing. 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. 10 ST-CertificateTrust - Revised 12/2008

Wyoming Secretary of State
State Capitol Building, Room 110 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: [email protected]

Consent to Appointment By Registered Agent
I,
(name of registered agent)

, registered office located at

(registered office address, city, state & zip)

voluntarily consent to serve as the registered agent for

(name of business entity)

on the date shown below.

I hereby certify that I am in compliance with the requirements of W.S. 17-28-101 through W.S. 17-28-111.

Signature:__________________________________________
(Shall be executed by the registered agent.)

Date:
(mm/dd/yyyy)

Print Name: Title:

Contact Person: Daytime Phone: Email:

Checklist Submit one originally signed consent to appointment and one exact photocopy.

RAConsent ­ Revised 06/16/2009