Free Microsoft Word - RA-ROChangeByEntity2 - Wyoming

Wyoming Secretary of State
State Capitol Building, Room 110 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: [email protected]

For Office Use Only

Statement of Change of Registered Agent and/or Registered Office By Business Entity
1. Name of the business entity: 2. Name of its current registered agent and street address of its current registered office: Current Registered Agent: Current Registered Office: 3. Name of its new registered agent and physical Wyoming address of its new registered office: New Registered Agent:
For consistency the Secretary of State's Office will only keep one version of the agent's name on file.

New Registered Office: 4. I hereby certify that the new registered office and the registered agent comply with the requirements of W.S. 17-28-101 through W.S. 17-28-111. 5. The mailing address should be changed to reflect the new registered office address. 6. The principal address should be changed to reflect the new registered office address. Yes Yes No No

7. A separate notice must be provided to change the mailing and/or principal office address if different than the new registered office address. 8. After the changes are made, the street address of its registered office and the business office of its registered agent will be identical. Date:
(mm/dd/yyyy)

Signature: ______________________________________________
(Shall be executed by an authorized individual.)

Print Name: Contact Person: Daytime Phone Number:
Checklist Filing Fee: Nonprofit Corporation - $3.00 (by statute); All other business entities - No Fee The Statement must be accompanied by a written consent to appointment executed by the registered agent. Please submit one originally signed document and one exact photocopy of the filing. Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in the processing of your documents. RA-RO ChangeByEntity ­ 5/21/2009

Title: Email:

Wyoming Secretary of State
State Capitol Building, Room 110 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: [email protected]

Consent to Appointment By Registered Agent
I,
(name of registered agent)

, registered office located at

(registered office address, city, state & zip)

voluntarily consent to serve as the registered agent for

(name of business entity)

on the date shown below.

I hereby certify that I am in compliance with the requirements of W.S. 17-28-101 through W.S. 17-28-111.

Signature:__________________________________________
(Shall be executed by the registered agent.)

Date:
(mm/dd/yyyy)

Print Name: Title:

Contact Person: Daytime Phone: Email:

Checklist Submit one originally signed consent to appointment and one exact photocopy.

RAConsent ­ Revised 06/16/2009