Free Microsoft Word - F0120 - Mississippi

11 F0120 - Page 1 of 1

OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1633

Application for Appointment of Registered Agent
1. Name of the Limited Liability Company Business email address________________________________

2. It was organized under the laws of the state or other jurisdiction of

3. Name and Street Address of the Registered Agent and Registered Office are Name Physical Address P.O. Box City, State, ZIP5, ZIP4
is designated and appointed registered agent of this Limited Liability Company in the State of Mississippi upon whom service of process against this Limited Liability Company may be had in the event of any suit against this Limited Liability Company in said State; and that all prior designations and appointments of registered agents, if any, be and the same hereby revoked. Witness my signature, and the SEAL of said Company, this the day of (year)

By:

Signature

(Please keep writing within blocks)

Printed Name

Title

The undersigned hereby accepts the above description and appointment of registered agent for service of process

Dated in

Mississippi, the

day of

(year) (Please keep writing within blocks)

Signature of Registered Agent

Rev. 06/09