"Change of Agent - Foreign (Formed Outside of Connecticut) - All Entities" - Connecticut

The Connecticut Secretary of the State has released this version of the "Change of Agent - Foreign (Formed Outside of Connecticut) - All Entities" on July 1, 2017.

This form may be used by all Connecticut residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Change of Agent - Foreign (Formed Outside of Connecticut) - All Entities" - 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
Foreign (FORMED OUTSIDE OF CONNECTICUT)
All Entities
C.G.S. §§ 33-927; 33-1217; 34-38p; 34-243n; 34-408; 34-429; 34-532
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 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 BUSINESS ENTITY IN STATE OR COUNTRY OF FORMATION:
2. THE NAME UNDER WHICH THE BUSINESS ENTITY TRANSACTS BUSINESS IN CONNECTICUT, IF
DIFFERENT FROM NAME STATED IN NUMBER 1 ABOVE,
(IF APPLICABLE):
3. STATE/COUNTRY OF FORMATION:
4. APPOINTMENT OF NEW AGENT FOR SERVICE OF PROCESS: THE BUSINESS ENTITY MAY NOT BE
APPOINTED AS ITS OWN AGENT; HOWEVER A PRINCIPAL OF THE BUSINESS ENTITY RESIDING IN
CONNECTICUT MAY BE THE AGENT. (CHECK A COMPLETE B OR SEE #5 IF APPLICABLE)
A. THE BUSINESS ENTITY APPOINTS THE SECRETARY OF THE STATE OF CONNECTICUT AND HIS/
HER SUCCESSORS IN OFFICE TO BE ITS AGENT, UPON WHOM ANY PROCESS, IN ANY ACTION OR
PROCEEDING AGAINST IT, MAY BE SERVED.
B. IF AGENT IS AN INDIVIDUAL:
PRINT OR TYPE FULL LEGAL NAME:
CONNECTICUT RESIDENCE ADDRESS:
BUSINESS ADDRESS:
(P.O.BOX UNACCEPTABLE)
(IF NONE, MUST STATE “NONE”)
(P.O.BOX UNACCEPTABLE)
STREET:
STREET:
CITY:
CITY:
STATE:
ZIP:
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
Foreign (FORMED OUTSIDE OF CONNECTICUT)
All Entities
C.G.S. §§ 33-927; 33-1217; 34-38p; 34-243n; 34-408; 34-429; 34-532
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 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 BUSINESS ENTITY IN STATE OR COUNTRY OF FORMATION:
2. THE NAME UNDER WHICH THE BUSINESS ENTITY TRANSACTS BUSINESS IN CONNECTICUT, IF
DIFFERENT FROM NAME STATED IN NUMBER 1 ABOVE,
(IF APPLICABLE):
3. STATE/COUNTRY OF FORMATION:
4. APPOINTMENT OF NEW AGENT FOR SERVICE OF PROCESS: THE BUSINESS ENTITY MAY NOT BE
APPOINTED AS ITS OWN AGENT; HOWEVER A PRINCIPAL OF THE BUSINESS ENTITY RESIDING IN
CONNECTICUT MAY BE THE AGENT. (CHECK A COMPLETE B OR SEE #5 IF APPLICABLE)
A. THE BUSINESS ENTITY APPOINTS THE SECRETARY OF THE STATE OF CONNECTICUT AND HIS/
HER SUCCESSORS IN OFFICE TO BE ITS AGENT, UPON WHOM ANY PROCESS, IN ANY ACTION OR
PROCEEDING AGAINST IT, MAY BE SERVED.
B. IF AGENT IS AN INDIVIDUAL:
PRINT OR TYPE FULL LEGAL NAME:
CONNECTICUT RESIDENCE ADDRESS:
BUSINESS ADDRESS:
(P.O.BOX UNACCEPTABLE)
(IF NONE, MUST STATE “NONE”)
(P.O.BOX UNACCEPTABLE)
STREET:
STREET:
CITY:
CITY:
STATE:
ZIP:
STATE:
ZIP:
SIGNATURE ACCEPTING APPOINTMENT:
X
PAGE 1 OF 2
Rev. 7/2017
(DO NOT COMPLETE 4C IF AGENT APPOINTED AT 4A OR 4B)
C. IF AGENT 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:
5. CONNECTICUT MAILING ADDRESS OF REGISTERED AGENT :
( REQUIRED FOR FOREIGN LIMITED
LIABILITY COMPANIES ONLY )
( P.O. BOX IS ACCEPTABLE )
STREET OR PO BOX:
CITY:
STATE:
ZIP:
6. EXECUTION:
(SUBJECT TO PENALTY OF FALSE STATEMENT)
DATE (MM/DD/YYYY)
NAME OF SIGNATORY
SIGNATURE
CAPACITY/TITLE OF SIGNATORY
PAGE 2 OF 2
Rev. 7/2017
INSTRUCTIONS
1. Please provide the complete name of the business entity.
2. Provide the complete name under which the business entity transacts business in Connecticut as it currently
appears on the records of the Secretary of the State if other than the name stated in item number 1.
3. Please provide the business entity’s state or country of formation.
4. The business entity may appoint either:
A. The Secretary of the State
OR
B. 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/her business (if none, must state “none”) and a Connecticut residence
Address. Agent must sign accepting the appointment.
OR
• 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 4B.
• Print the name & title under the signature of the individual signing acceptance on behalf of the business agent.
5. A foreign limited liability company must provide the agent's Connecticut mailing address (if the Secretary
of the State is not appointed agent).
6. The document must be executed/signed by an authorized official of the business entity. That person must print or
type their name, state the capacity/title under which they sign and provide a 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
Rev. 7/2017
INSTRUCTIONS
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