Free Consent to Service of Process - Michigan

BCS/LCL-900 (4/09) Michigan Department of Energy, Labor & Economic Growth Bureau of Commercial Services Licensing Division P.O. Box 30018, Lansing, MI 48909 www.michigan.gov/commerciallicensing 517-241-9288; Fax 517-373-3085

CONSENT TO SERVICE OF PROCESS
AUTHORITY: P.A. 299 of 1980, as amended COMPLETION: Mandatory PENALTY: Failure to complete may result in denial of your application.
Information provided on this form may be released to the public in accordance with the Freedom of Information Act, 1976 PA 442, as amended.

Name of Applicant

License, Registration or Listing applying for (builder, real estate, etc.)

Street Address

City

State

Zip Code

Type of Application (check one) Individual Organization (corporation, limited liability company, partnership, etc.)

If Applicant is an Organization, Name the State in which you are organized.

KNOW ALL PERSONS BY THESE PRESENTS: For the purpose of complying with the laws of the State of Michigan, the undersigned irrevocably appoints the Director of the Licensing Division, Bureau of Commercial Services in the Michigan Department of Energy, Labor & Economic Growth, or his/her successor in office, to be his/her/its attorney to receive service of any lawful process in any non-criminal suit, action, or proceeding against him/her/it, or his/her/its successor, executor, or administrator, which may arise under the Occupational Code (being Act number 299 of the Public Acts of 1980, as amended) or any rule or order thereunder after the filing hereof. The undersigned does hereby consent that any such action, or proceeding against him/her/it may be commenced in any court of competent jurisdiction and proper venue within the State of Michigan by service of process upon said Director with the same force and validity as if served upon the undersigned by service personally on its president or other chief officer, if a corporation, or on one of its partners, if a partnership, or on one of its members, if a limited liability company, or on the individual, if an individual. Signed in the City of , State of

this

day of

, 20

. Signed
Name of Applicant

By
If an Organization

Title State of

County of

Subscribed and sworn before me this

day of

, 20

Signature of Notary Public

My commission expires

County of

State of

If a Corporation, execute and attach a resolution authorizing Consent to Service of Process.
DELEG is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.