"Change of Agent - Domestic (Domestic Formed in Connecticut) - All Entites" - Connecticut

Change of Agent - Domestic (Domestic Formed in Connecticut) - All Entites is a legal document that was released by the Connecticut Secretary of the State - a government authority operating within Connecticut.

Form Details:

  • Released on October 1, 2017;
  • The latest edition currently provided by the Connecticut Secretary of the State;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

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Download "Change of Agent - Domestic (Domestic Formed in Connecticut) - All Entites" - Connecticut

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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:
CHANGE OF AGENT
DOMESTIC (DOMESTIC FORMED IN CONNECTICUT)
ALL ENTITES
C.G.S. § 33-661; 33-1051; 34-13b; 34-243n; 34-408; 34-507
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 8
1/2
X 11 SHEETS IF NECESSARY.
FILING FEE: $50
FILING PARTY
:
(CONFIRMATION WILL BE SENT TO THIS ADDRESS)
EXCEPTION: $20.00 FILING FEE FOR
NONSTOCK (NONPROFIT) CORPORATIONS
NAME:
& LIMITED PARTNERSHIPS.
MAKE CHECKS PAYABLE TO "SECRETARY
MAILING ADDRESS:
OF THE STATE"
CITY:
STATE:
ZIP:
1. NAME OF ENTITY - REQUIRED:
(MUST MATCH OUR RECORDS EXACTLY. INCLUDE BUSINESS DESIGNATION I.E. L.L.C., LLC,
INC, ETC.):
2. APPOINTMENT OF NEW AGENT:
(COMPLETE A OR B, NOT BOTH)
A. IF AGENT IS AN INDIVIDUAL:
PRINT OR TYPE FULL LEGAL NAME:
BUSINESS ADDRESS
CONNECTICUT RESIDENCE ADDRESS
(P.O.BOX UNACCEPTABLE)
IF NONE, MUST STATE “NONE”
(P.O.BOX UNACCEPTABLE)
STREET:
STREET:
CITY:
CITY:
STATE:
ZIP:
STATE:
ZIP:
CONNECTICUT MAILING ADDRESS OF REGISTERED AGENT:
( REQUIRED FOR ALL LLC'S AND DOMESTIC STOCK
CORPORATIONS ): (P.O.BOX IS ACCEPTABLE)
STREET OR PO BOX:
CITY:
STATE:
ZIP:
SIGNATURE ACCEPTING APPOINTMENT: X
PAGE 1 OF 2
Rev. 7/2017
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:
CHANGE OF AGENT
DOMESTIC (DOMESTIC FORMED IN CONNECTICUT)
ALL ENTITES
C.G.S. § 33-661; 33-1051; 34-13b; 34-243n; 34-408; 34-507
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 8
1/2
X 11 SHEETS IF NECESSARY.
FILING FEE: $50
FILING PARTY
:
(CONFIRMATION WILL BE SENT TO THIS ADDRESS)
EXCEPTION: $20.00 FILING FEE FOR
NONSTOCK (NONPROFIT) CORPORATIONS
NAME:
& LIMITED PARTNERSHIPS.
MAKE CHECKS PAYABLE TO "SECRETARY
MAILING ADDRESS:
OF THE STATE"
CITY:
STATE:
ZIP:
1. NAME OF ENTITY - REQUIRED:
(MUST MATCH OUR RECORDS EXACTLY. INCLUDE BUSINESS DESIGNATION I.E. L.L.C., LLC,
INC, ETC.):
2. APPOINTMENT OF NEW AGENT:
(COMPLETE A OR B, NOT BOTH)
A. IF AGENT IS AN INDIVIDUAL:
PRINT OR TYPE FULL LEGAL NAME:
BUSINESS ADDRESS
CONNECTICUT RESIDENCE ADDRESS
(P.O.BOX UNACCEPTABLE)
IF NONE, MUST STATE “NONE”
(P.O.BOX UNACCEPTABLE)
STREET:
STREET:
CITY:
CITY:
STATE:
ZIP:
STATE:
ZIP:
CONNECTICUT MAILING ADDRESS OF REGISTERED AGENT:
( REQUIRED FOR ALL LLC'S AND DOMESTIC STOCK
CORPORATIONS ): (P.O.BOX IS ACCEPTABLE)
STREET OR PO BOX:
CITY:
STATE:
ZIP:
SIGNATURE ACCEPTING APPOINTMENT: X
PAGE 1 OF 2
Rev. 7/2017
NOTE: DO NOT COMPLETE 2B IF 2A IS COMPLETED
B. IF AGENT IS A BUSINESS:
PRINT OR TYPE NAME OF BUSINESS AS IT APPEARS ON OUR RECORDS:
CONNECTICUT BUSINESS ADDRESS
(P.O.BOX UNACCEPTABLE)
STREET:
CITY:
STATE:
ZIP:
SIGNATURE ACCEPTING APPOINTMENT ON BEHALF OF AGENT:
X
PRINT NAME & TITLE OF PERSON SIGNING ON BEHALF OF AGENT:
CONNECTICUT MAILING ADDRESS OF REGISTERED AGENT:
( REQUIRED FOR ALL LLC'S AND DOMESTIC STOCK
CORPORATIONS ): (P.O.BOX IS ACCEPTABLE)
STREET OR PO BOX:
CITY:
STATE:
ZIP:
3.EXECUTION:
(SUBJECT TO PENALTY OF FALSE STATEMENT)
DATE (MM/DD/YYYY)
NAME OF SIGNATORY
SIGNATURE
CAPACITY/TITLE OF SIGNATORY
(print/type)
Rev. 10/2017
PAGE 2 OF 2
INSTRUCTIONS
1. Name of entity: Please provide the complete name of the business entity, as it appears on the records of The
Secretary of the State. Include business designation (i.e. LLC, Inc, etc.) (MUST MATCH OUR RECORDS EXACTLY)
2. Appointment of new agent: The business entity may appoint either:
A. Any individual who is a resident of Connecticut, including a principal of the business entity. (An individual must
provide the complete street address of his or her business (If none, MUST state “NONE”) and a Connecticut
residence address. Appointed agent must sign acceptance of appointment.
or
B. Any of the following business types, on record with this office:
• A Connecticut corporation, limited liability company, limited liability partnership or statutory trust
• A foreign corporation, limited liability company, limited liability partnership or statutory trust, which has obtained a
certificate of authority to transact business in Connecticut and has a Connecticut address on file with this office
• The business must provide a Connecticut business address in Box 2B.
• Print the name & title under the signature of the individual signing acceptance on behalf of the business agent.
NOTE: The entity may NOT appoint itself as its registered agent.
NOTE: LLC's and Domestic Stock Corporations must provide a Connecticut mailing address of appointed agent.
If the entity at line 1 is a domestic/Connecticut Limited Liability Company, it must provide the agent's Connecticut
mailing address (which may be a PO BOX).
3. Execution: The document must be executed/signed by an authorized official of the business entity. That person must
print or type his or her full legal name, state the capacity/title under which he/she signs and provide his/her signature.
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
DO NOT SCAN THIS PAGE
INSTRUCTIONS
Rev. 10/2017
Page of 3