Free 26285.PDF - Indiana

STATEMENT OF RESIGNATION OF REGISTERED AGENT
Sta te Form 2 6285 (R6 / 1-03) Approved by Sta te Boa rd of A ccoun ts, 199 5

TODD RO KITA SECRETARY OF STATE CO RP ORATIO NS DIVIS ION 302 W. Washing ton St., Rm. E018 Ind ianap olis, IN 46204 T lephon e: (317) 232 -6576 e Ind iana Code 23-1 -24-3 (for profit corpora tion ) Ind iana Code 23-17 -6-3 (non -profit corpora tion )

INSTRUCTIONS:

Use 8 1/2" x 11" white paper for attachments. Present original and one copy to address in upper right corner of this form. Please TYPE or PRINT. Please visit our office on the web at www.sos.in.gov. REGISTERED AGENT STATEMENT

NO FILING FEE

I, the undersigned, hereby resign the appointment as the registered agent for the following entity:
Na me of Entity

REGISTERED OFFICE ADDRESS:
Add ress (numbe r an d street, city, state, ZIP code)

IN WITNESS WHEREOF, the undersigned being the registered agent of said Entity executes this resignation and verifies, subject to penalties of perjury, that the statements contained herein are true, this ______ day of ____________________________, 20 _______.
Signa ture Printed name

The agency appointment is hereby terminated, and the registered office is discontinued as so provided thirty-one (31) days from the date of filing of this statement.

OFFICE USE ONL Y

The Secretary of State has mailed one copy to the Corporation at its principal office and a copy to the registered office, if not discontinued.
Signa ture of Secretary of S tate

Signa ture of Dep uty