Free Filing Fee $50.00_________ - Rhode Island

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State Corporations Division 148 W. River Street Providence, Rhode Island 02904-2615

DESIGNATION OF AGENT FOR NONRESIDENT LANDLORD
Pursuant to the provisions of Section 34-18-22.3 of the General Laws, 1956, as amended, the undersigned landlord, who is not a resident of the State of Rhode Island, submits the following statement for the purpose of appointing an agent in the State of Rhode Island. 1. The name of the nonresident landlord is 2. The address of the nonresident landlord is

3. The name of the agent is
(The agent must be a resident of this state or a corporation authorized to do business in this state.)

4. The address of the agent is

5. List the street address of each property designated to said agent: Street Address City/Town

Under penalty of perjury, I declare and affirm that all statements, including any accompanying attachments, contained herein are true and correct.

Date: Signature of Landlord

NOTE:
Pursuant to the above statute, a designation of agent must also be filed with the clerk of the city or town wherein the dwelling unit is located. You should contact the city or town clerk prior to filing said designation to determine what additional filing requirements, if any, are necessary.

Form No. 34-18-22 Revised: 12/05