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@example.com
For Office Use Only
Statement of Resignation of Registered Agent
1. This change affects every entity that I represent. OR This change affects only the entities on the attached list. 2. I, agent for the entities listed on the attached list. 3. I hereby certify that notice of my resignation was sent on , hereby resign my agency appointment as the registered
to an officer or controlling (Date mm/dd/yyyy) member of the business entities to its last known address thirty (30) days prior to the filing of this statement with the Wyoming Secretary of State. 4. The resignation is effective immediately upon filing of this statement with the Wyoming Secretary of State. 5. If the registered office address is currently on file as the mailing and/or principal office address, a separate notice must be provided to change the mailing and/or principal office address to the last known address.
(Shall be executed by the registered agent.)
Print Name: Title: Contact Person: Daytime Phone Number: Email:
Checklist No Filing Fee 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.