Fill and Sign the Certificate of Revocation of Appointment of Registered Form

Certificate of Revocation of Appointment of Registered Church Agent Page 1 of 1 Certificate of Revocation of Appointment of Registered Church Agent of Nonprofit Corporation , of (Name of Secretary) (Name of Nonprofit Corporation) having a principal office at , certify that (Street Address, City, County, State, Zip Code) pursuant to ,said Corporation has revoked the appointment of (Identity of Statute) of , as its (Name of Resident Agent) (Street Address, City, County, State, Zip Code) resident agent and that the following is a true copy of the vote of the Directors revoking such appointment: For Revocation Against Revocation SIGNED UNDER THE PENALTIES OF PERJURY, this day of , 20 . _________________________________ (Signature of Secretary of Corporation) (Name of Secretary of Corporation) I hereby approve the within Certificate of Revocation of Appointment of Resident Agent and, the filing fee in the amount of $ having been paid, said certificate is deemed to have been filed with me this day of , 20 . (Name of Secretary of State) (Name of State) Contact information: TO BE FILLED IN BY CORPORATION Contact information: Telephone: Email: