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Fill and Sign the A Commercialregisteredagent Form

Fill and Sign the A Commercialregisteredagent Form

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BARBARA K. CEGAVSKE  Secretary of State  202 North Carson Street Carson City, Nevada 89701­4201 (775) 684­5708  Website:  www.nvsos.gov  Statement of Change of  Registered Agent  by Represented Entity  (PURSUANT TO NRS 77.340)  This form may be submitted by:  the Represented Entity to appoint a  new Registered Agent or amend own service of process info. For more  information please visit http://www.nvsos.gov/index.aspx?page=141  USE BLACK INK ONLY ­ DO NOT HIGHLIGHT  ABOVE SPACE IS FOR OFFICE USE ONLY  1. Name of Represented Entity:  2. Entity File Number:  3. This statement of change will have the following effect:  (check only one)  Appoints a new agent for service of process  (complete 4a or 4b)  Updates contact information of the Represented Entity acting as own agent  (complete 4c)  4. Information in effect upon the filing of this statement:  (complete only one section)  b)  Noncommercial Registered Agent:  a)  Commercial Registered Agent:  Name  Nevada  Name  Street Address  City Zip Code  Nevada  Zip Code City Mailing Address (if different from street address)  c)  Title of Office or Other Position within Represented Entity:  Name of Title or Position  Street Address  Mailing Address (if different from street address)  5. Signature of Represented Entity:  (required)  City  City  Authorized Signature  6. Registered Agent Acceptance:  (required)  I hereby accept appointment as Registered Agent for the above named Entity.  Nevada  Zip Code  Nevada  Zip Code  Date  Authorized Signature of Registered Agent or On Behalf of Registered Agent Entity  Date  FEE:  $60.00  Nevada Secretary of State Form RA Change by Entity This form must be accompanied by appropriate fees.  Revised: 1­5­15  X  X  *181004* *181004* BARBARA K. CEGAVSKE  Secretary of State  202 North Carson Street Carson City, Nevada 89701­4201 (775) 684­5708  Website:  www.nvsos.gov  Commercial Registered Agent  Registration  Statement of Change  (PURSUANT TO NRS 77.360)  This form may be submitted by  an agent that has filed a Commercial  Registered Agent Registration Statement with this office to amend the information in the original statement.  USE BLACK INK ONLY ­ DO NOT HIGHLIGHT  ABOVE SPACE IS FOR OFFICE USE ONLY  1. Name of Commercial Registered Agent as currently listed in Nevada:  2. Nevada Business ID#:  Name of Commercial Registered Agent 3. Information being changed:  (check all that apply)  Address  Email  Individual with Authority  Type  Jurisdiction  4. Commercial Registered Agent Information in effect upon filing of this statement:  Name of Individual:  Name of Entity:  or  Entity Type:  Jurisdiction of Organization:  5. The above listed person is in the business of serving as a commercial registered agent in Nevada.  The business  address of the person in this State to which service of process and other notice and documents being served on or sent to entities represented by it may be delivered is:  Nevada  Street Address City Zip Code  Nevada  Mailing Address (only if different from above)  City  Zip Code  6. Email address where electronic notices may be sent:  7. Individual who has the authority to act on behalf of the commercial registered agent:  Name:  Address:  Telephone:  Street Address  City State  Zip Code  8. Required Statement:  The person registering as a commercial registered agent or each director, officer or managing agent of a commercial registered agent has not been  convicted of a felony, and if convicted of a felony, the individual has had his or her civil right restored.  The registered agent has not had his or her ability to serve as a registered agent or a director, officer or managing agent of a registered agent denied or revoked by appropriate authority of this state or another state or enjoined by a court of competent jurisdiction from serving as a registered agent because the individual engaged in conduct as a registered agent that was intended to or likely deceive or defraud the public.  9. Signature:  I declare, to the best of my knowledge under penalty of perjury, that the information contained herein is correct and acknowledge that pursuant to NRS  239.330, it is a category C felony to knowingly offer any false or forged instrument for filing in the Office of the Secretary of State.  Authorized Signature of Individual or On Behalf of Entity  Date  FEE:  $60.00  Nevada Secretary of State Form Change by CRA  Revised:  1­5­15 This form must be accompanied by appropriate fees.  X  *180204* *180204* BARBARA K. CEGAVSKE  Secretary of State  202 North Carson Street Carson City, Nevada 89701­4201 (775) 684­5708  Website:  www.nvsos.gov  Statement of Change by  Noncommercial  Registered Agent  (PURSUANT TO NRS 77.350)  This form may be submitted by:  a Noncommercial Registered Agent  to update their name or address for service of process.  For more  information please visit http://www.nvsos.gov/index.aspx?page=141  USE BLACK INK ONLY ­ DO NOT HIGHLIGHT  ABOVE SPACE IS FOR OFFICE USE ONLY  1. Name of Entity Represented:  2. Entity File Number:  3. Name and Address of Noncommercial Registered Agent of record before change:  Name  Nevada  Street Address City Zip Code  Nevada  Zip Code City Mailing Address (if different from street address)  4. Name and Address of Noncommercial Registered Agent upon the filing of this document:  Name  Nevada  Street Address City Zip Code  Nevada  Zip Code City Mailing Address (if different from street address)  5. Signature of Noncommercial Registered Agent:  Authorized Signature of Registered Agent or On Behalf of Registered Agent Entity  Date  FEE:  $60.00  Nevada Secretary of State Form Change by NonCRA This form must be accompanied by appropriate fees.  Effective 1­5­15  X  *180604* *180604* BARBARA K. CEGAVSKE  Secretary of State  202 North Carson Street Carson City, Nevada 89701­4201 (775) 684­5708 Customer Order Instructions  Website:  www.nvsos.gov  SUBMIT THIS COMPLETED FORM  WITH YOUR FILING  USE BLACK INK ONLY ­ DO NOT HIGHLIGHT  Processing  24­Hour Expedite  (additional fee included) Regular Service Requested:  Date:  Phone:  Name of Entity:  Contact Name:  Return to:  Return Delivery:  (email or fax options do not receive a copy via mail; must be ordered separately)  Hold for Pick Up  Mail to Address Above  Fax to: Email to:  Other:  (explain below)  FedEx: Acct #  Order Description:  (include items being ordered and fee breakdown) *  Total Amount: *PLEASE NOTE: this office keeps the original paperwork.  The first file  stamped copy ordered at the time of filing is at no charge.  Each additional  copy is  $2.00 per page (plus  $30.00 for each certification).  Method of Payment:  Check/Money Order  Credit Card  (attach ePayment checklist)  Trust Account:  Use balance remaining in job #  Nevada Secretary of State Customer Order Instructions  Revised:  1­5­15  *230305* *230305* ePayment Checklist    (For Counter, Fax and Mail Requests) BARBARA K. CEGAVSKE  Secretary of State  202 North Carson Street Carson City, Nevada 89701­4201  (775) 684­5708 Website:  www.nvsos.gov USE BLACK INK ONLY ­ DO NOT HIGHLIGHT  Service Type:  Counter  Mail  Fax Order Processing Requested: (Expedite Processing Requires Additional Fees)  Regular Processing  24­HOUR  Expedite 2­HOUR Expedite 1­HOUR Expedite Payment by Card  (card holder name and billing address required below) Card Type:  VISA  MasterCard  Discover American Express  Customer Credit Card Number:  V CODE *  * 3­digit number found on the far right of the backside of VISA, MasterCard and Discover cards 4­digit number found on the front right side of American Express card. NOTICE:  For security and verification purposes, all credit card payments must include the 3 or 4­digit CVV2 code  (VCode) number located on the credit card.  Failure to include this code will result in the rejection of your filing or service  request.  Credit Card Expiration Date:  Month  Year  Amount to Charge Card:  USD $ Order Information  (required)  Entity Name/Order Reference:  Card Holder Information:  Name as it Appears on the Account  Billing Address  City, State, Zip  Telephone  Payment Authorization  I authorize the Secretary of State to bill an amount not to exceed the following to be charged to the above listed  account(s):  Not to Exceed Amount: USD $ Authorized Signature  Nevada Secretary of State ePayment Checklist Revised: 1­5­15  X  Ext *230105* *230105*

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