Free CFD-04 - Arkansas

Arkansas Secre t a ry of State
Charlie Daniels
State Capitol · Little Rock, Arkansas 72201-1094 501-682-3409 · www.sos.arkansas.gov

Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock

Appointment of Agent for Service of Process By Foreign Bank or Trust Company
I, as President and I, , as Secretary of the Board of Trustees or Directors of , organized under the laws of the State of , hereby certify that pursuant to Act 947 of 1989, the person or entity below is hereby designated as Agent for Service of Process upon whom all notices and processes issued by any court of this State may be served in any action or proceeding relating to said bank, trust, fund, society, association or insurance company within this State with which the said is act-

ing in any fiduciary capacity, including any acts, omissions, or defaults with respect to any such bank, trust, fund, society, association or insurance company.

Name

Street and number

City

State

ZIP

Witness our hands this

day of

,

.

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.

President

Secretary Subscribed and sworn to before me, a of , this day of , within and for the County , .

My Commission Expires:

Notary Public
CFD-04 Rev. 4/06