Free - - Mississippi

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

Application for Appointment of Registered Agent Of a Foreign Business Trust
1. Name of Foreign Business Trust

2. It is Organized under the laws of

3. Registered Agent

Is designated and appointed registered agent of this foreign business trust in the State of Mississippi upon whom service of process against this business trust may be had in the event of any suit against this business trust in said State: and that all prior designations and appointments of registered agents, if any, be and the same are hereby revoked. Witness my signature, and SEAL of said Business Trust, this day of AD, (year)

By:

Signature

Printed Name

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

Dated

In Mississippi

day of

AD,

(year)

(Please keep writing within blocks)

Signature of Registered Agent

Physical Address

P. O. Box City, State, Zip5,Zip4

Rev. 07/98