Free ApptAgenttoReceiveServ. - Arkansas


File Size: 187.2 kB
Pages: 1
Date: May 24, 2007
File Format: PDF
State: Arkansas
Category: Corporations
Author: Administrator
Word Count: 219 Words, 1,309 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.sosweb.state.ar.us/corp_ucc/corp_forms/forms/ApptAgenttoReceiveServ.pdf

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

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

Appointment of Agent to Receive Service of Process for Nonprofit Association
(Please Type or Print)

Name of Nonprofit Association: Federal tax Identification Number (if any): Address:

Name and street address of person authorized as agent to receive service of process:

I, , do hereby appoint the above-stated person as agent to receive service of process. I am authorized to manage the affairs of the nonprofit association.
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.

Authorizing Officer (Type or Print) Authorized Signature Date

I, receive service of process.

, do hereby accept this appointment as agent to

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.

Signature

Date

Filing Fee: $25.00 payable to Arkansas Secretary of State

Rev. 4/06