Form CINC-1-1.0 Interim Notice of Change of Officer/Director - Connecticut

Form CINC-1-1.0 is a Connecticut Secretary of the State form also known as the "Interim Notice Of Change Of Officer/director". The latest edition of the form was released in July 1, 2010 and is available for digital filing.

Download a fillable PDF version of the Form CINC-1-1.0 down below or find it on Connecticut Secretary of the State Forms website.

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SECRETARY OF THE STATE OF CONNECTICUT
MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470
DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106
860-509-6003
www.concord-sots.ct.gov
PHONE:
WEBSITE:
INTERIM NOTICE OF CHANGE OF
OFFICER/DIRECTOR
DOMESTIC AND FOREIGN CORPORATIONS
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY.
FILING FEE: $20
FILING PARTY
:
(CONFIRMATION WILL BE SENT TO THIS ADDRESS)
MAKE CHECKS PAYABLE TO "SECRETARY
OF THE STATE"
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
1. NAME OF CORPORATION:
2. NEW OFFICER/DIRECTOR INFORMATION:
NAME
TITLE
RESIDENCE ADDRESS
BUSINESS ADDRESS
CHECK IF DIRECTOR
CHECK IF DIRECTOR
CHECK IF DIRECTOR
3. DIRECTORS/OFFICERS WHO HAVE CEASED TO HOLD OFFICE:
NAME
TITLE
NAME
TITLE
CHECK IF DIRECTOR
CHECK IF DIRECTOR
CHECK IF DIRECTOR
CHECK IF DIRECTOR
4. EXECUTION:
DATED THIS
DAY
, 20
CAPACITY/TITLE OF SIGNATORY
SIGNATURE
NAME OF SIGNATORY
(PRINT/TYPE)
FORM CINC-1-1.0
PAGE 1 OF 1
Rev. 7/2010
SECRETARY OF THE STATE OF CONNECTICUT
MAILING ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O. BOX 150470, HARTFORD, CT 06115-0470
DELIVERY ADDRESS: COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 TRINITY STREET, HARTFORD, CT 06106
860-509-6003
www.concord-sots.ct.gov
PHONE:
WEBSITE:
INTERIM NOTICE OF CHANGE OF
OFFICER/DIRECTOR
DOMESTIC AND FOREIGN CORPORATIONS
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEETS IF NECESSARY.
FILING FEE: $20
FILING PARTY
:
(CONFIRMATION WILL BE SENT TO THIS ADDRESS)
MAKE CHECKS PAYABLE TO "SECRETARY
OF THE STATE"
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
1. NAME OF CORPORATION:
2. NEW OFFICER/DIRECTOR INFORMATION:
NAME
TITLE
RESIDENCE ADDRESS
BUSINESS ADDRESS
CHECK IF DIRECTOR
CHECK IF DIRECTOR
CHECK IF DIRECTOR
3. DIRECTORS/OFFICERS WHO HAVE CEASED TO HOLD OFFICE:
NAME
TITLE
NAME
TITLE
CHECK IF DIRECTOR
CHECK IF DIRECTOR
CHECK IF DIRECTOR
CHECK IF DIRECTOR
4. EXECUTION:
DATED THIS
DAY
, 20
CAPACITY/TITLE OF SIGNATORY
SIGNATURE
NAME OF SIGNATORY
(PRINT/TYPE)
FORM CINC-1-1.0
PAGE 1 OF 1
Rev. 7/2010
INSTRUCTIONS FOR COMPLETION OF THE INTERIM NOTICE OF CHANGE OF
OFFICER/DIRECTOR FORM Domestic and Foreign Corporations
Instructions correspond with numbered entries on the form
1. NAME OF CORPORATION: Please provide the complete name of the corporation as it currently appears on the
records of the Secretary of the State. If the notice is being filled by a foreign corporation, such corporation should
provide the name under which it is currently authorized to transact business in Connecticut.
2. NEW OFFICER/DIRECTOR INFORMATION: Please print or type the full name of the corporation's officers and
directors, their titles, including a check following the statement "Check if Director" if applicable, and their residence
and business addresses. Complete street addresses including a street number, street name, city, state, postal code
and country if other than the United States are required. Note: P.O. boxes are only acceptable as additional
information.
3. DIRECTORS/OFFICERS WHO HAVE CEASED TO HOLD OFFICE: Please print or type the full name of
directors/officers who have ceased holding director or officer positions within the corporation and their titles, including
a check following the statement "Check if Director" if applicable.
4. EXECUTION: The document must be executed by an authorized official of the corporation. That person must print or
type their name, state the capacity under which they sign. The execution constitutes a legal statement under the
penalties of false statement that the information provided in the document is true.
OFFICE OF THE SECRETARY OF THE STATE
MAILING ADDRESS:
COMMERCIAL RECORDING DIVISION
CONNECTICUT SECRETARY OF THE STATE
P.O. BOX 150470
HARTFORD, CT 06115-0470
DELIVERY ADDRESS:
COMMERCIAL RECORDING DIVISION
CONNECTICUT SECRETARY OF THE STATE
30 TRINITY STREET
HARTFORD, CT 06106
PHONE: 860-509-6003
WEBSITE:
www.concord-sots.ct.gov
FORM CINC-1-1.0
DO NOT SCAN THIS PAGE
INSTRUCTIONS
Rev. 7/2010

Download Form CINC-1-1.0 Interim Notice of Change of Officer/Director - Connecticut

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