Free Registration of Commercial Registered Agent - Wyoming

Wyoming Secretary of State
Compliance Division State Capitol Building 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.7370 Fax 307.777.7640 Email: [email protected]

For Office Use Only

Commercial Registered Agent Registration
1. Legal name of applicant. (An applicant may be a natural person or business entity. If a natural person, the individual must be 18
years or older.):

For consistency the Secretary of State's Office will only keep one version of the agent's name on file.

2. The applicant's physical address (a post office box is prohibited) in Wyoming where service of process may be made during regular business hours for entities served by the applicant: Address:

City and Zip Code: Business Hours for Service of Process: Phone Number: 3. Mailing address of the applicant if different:

4. If the applicant is a business entity, the name, address and phone number of the natural person(s) who has responsibility for the entity: Name: Address:

City, State and Zip Code: Phone Number: 5. By signing this application, I agree: To comply with the provisions of the W.S. §17-28-101 ­ 17-28-111. That the applicant, or in the case of business entity, its officers, directors, partners, or persons serving in a similar capacity have not been convicted of a felony. That the name of natural person(s) or the position(s) that is authorized to accept service of process on behalf of the Commercial Registered Agent shall be held on site at the registered office. That this registration expires on December 31 of each year. A registered agent who does not renew by December 31 of each year shall not have registered agent status. That information contained on this application may be published on the Secretary of State's website: · Yes No

I declare under the penalty of perjury that the statements contained in this application are true and correct and acknowledge that pursuant to W.S. §6-5-308 it is a felony to knowingly offer a false or forged instrument for filing with the Secretary of State.

Date:
(mm/dd/yyyy)

Signature: ___________________________________________ Print Name: Title:

State of _______________________ S.S. County of ______________________

____________________________________________________, being first duly sworn, deposes and says that he has read the above application, and the facts set out therein are true. Date: _________________________ Signature: _____________________ Subscribed and sworn to before me this _____________day of ________________________________, 20___.

____________________________________________________ Notary Public My Commission Expires: ______________________________

Checklist Filing Fee: $25.00 Make check or money order payable to Wyoming Secretary of State.

CommercialRARegistration ­ Revised 3/2009