Fill and Sign the Fillable Online of Withdrawal from Fax Email Print pdfFiller Form

FILE ONE ORIGINAL (Two if you want a filed stamped copy returned to you) FEE: $15.00 1.The company filing this change CorporationLimited Partnership Insurance Company/Agency 2. Company Name Principal Office Addressas Registered. Home State: WV Formation Date: 3. (Note: Use appropriate lines for the type of address to be changed): 4. Change of Agent for Service of Process (per §31D-5-502 of the West Virginia Code) : a. Current Agent Name a. b. New Agent Name and Address b. The agent named here has given consent to appointment as agent to accept service of process on behalf of this company. New Agent Signature : X West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov APPLICATION TO APPOINT OR CHANGE PROCESS, OFFICERS, AND/OR ADDRESSES Limited Liability Company Limited Liability Partnership Voluntary Association Business Trust is registered as a ( check one): The change is filed for : (Note: Enter information as previously filed. No change can be accepted without this information.) Change of Address: Address Type New Address a. Principal Office b. Principal Mailing c. Designated Office Form AAO Rev. 11/2017 Application to Appoint or Change Process, Officers and/or Addresses Page 2 5. Complete the Change of Officers or Other Persons in Authority : Officer Type New Officer Name New Officer Address (check one for each new officer) a. President (Corp., Vol. Assn.) Member/Manager (LLC) General Partner (LP, LLP) Trustee (Bus. Trust) Other _ Remove (previous officer name, if any) b. Vice President (Corp., Vol. Assn.) Member/Manager (LLC) General Partners (LP, LLP) Trustee (Bus. Trust) Other Remove (previous officer name, if any) c. Secretary (Corp., Vol. Assn.) _ Member/Manager (LLC) Limited Partner (LP) General Partner (LLP) Trustee (Bus. Trust) Remove (previous officer name, if any) Other _ d. Treasurer (Corp., Vol. Assn.) _ Member/Manager (LLC) Limited Partner (LP) General Partner (LLP) _ Trustee (Bus. Trust) Remove (previous officer name, if any) Other _ e. Director (Corp., Vol. Assn.) Member/Manager (LLC) Limited Partner (LP) General Partner _ Trustee (Bus. Trust) Remove (previous officer name, if any) Other 6. Update/change E-mail Address ( ex: name@domain.com ) : 7. Name and phone number of contact person. ( This information is optional, however, if there is a problem with the filing, listing a contact person may avoid having to return or \ reject the document. ) Contact Name Phone Number 8. Signature Information (See below *Important Legal Notice Regarding Signature ): Print Name ofSigner: Title/Capacity: Signature: X Date: * Important Legal Notice Regarding Signature : Corporations/Voluntary Associations/Business Trusts/Unincorporated Nonprofit Associations/Limit\ ed Partnerships - Per West Virginia Code §31D-1- 129 . Penalty for signing false document. Any person who signs a document he or she knows is false in any material\ respect and knows that the document is to be delivered to the Secretary of State for filing is guilty of a misdeme\ anor and, upon conviction thereof, shall be fined not more than one thou\ sand dollars or confined in the county or regional jail not more than one year, or both.\ Limited Liability Companies/Limited Liability Partnerships - Per West Virginia Code §31B-2-209 . Liability for false statement in filed record. If a record authorized or required to be filed under this chapter contai\ ns a false statement, one who suffers loss by reliance on the statement may recover damages for the lo\ ss from a person who signed the record or caused another to sign it on t\ he person's behalf and knew the statement to be false at the time the record was signed. Important Note : This form is a public document. Please do NOT provide any personal identifiable information on this form such as social security number, bank account numbers, credit card numbers, tax identification or driver’\ s license numbers. CHOOSE ONE OF THE FOLLOWING PROCESSING SERVICES: 1 EXPEDITED SERVICE (24-hour, 2-hour and 1-hour; *Requires standard filing fee plus additional expedite fee, see below) West Virginia Secretary of State Business & Licensing Division Tel: (304) 558-8000 Fax: (304) 558-8381 Website: www.wvsos.gov Filing Submission Instructions - Business Division SUBMIT THE COMPLETED APPLICATION WITH THE CUSTOMER ORDER REQUEST FORM TO ONE OF THE OFFICES BELOW. CHOOSE EXPEDITED OR STANDARD PROCESSING SERVICE. IF NOT U\ SING THE CUSTOMER ORDER REQUEST FORM AND YOU ARE REQUESTING EXPEDITED SERVICE, YOU MUST IN\ CLUDE THE WORD "EXPEDITE" AND THE LEVEL OF EXPEDITED SERVICE BEING REQUESTED (24-HOUR,\ 2-HOUR OR 1-HOUR) IN YOUR CORRESPONDENCE. BE SURE TO INCLUDE THE CORRECT ADDITIONAL EXPEDITED\ FEE. THIS FEE IS IN ADDITION TO THE REGULAR FILING FEE ( SEE FEES BELOW). BUSINESS SERVICE CENTERS Standard and Expedited Filings Charleston Office One-Stop Business Center 1615 Washington Street East Charleston, WV 25311 Phone: (304) 558-8000 Fax: (304) 558-8381 Hours: Mon. - Fri. 8:30a - 5:00p EST Clarksburg Office North Central WV Business Center 200 West Main Street Clarksburg, WV 26301 Phone: (304) 367-2775 Fax: (304) 627-2243 Hours: Mon. -Fri. 9:00a - 5:00p EST IMPORTANT: READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING FORMS. Please follow the instructions included with the application. Failure to\ include any of the required information on the form may cause the filing to be rejected. All forms may be downloaded from our web site www.wvsos.gov . Rev. 9/2018 *Fee $ 25.00 $250.00 $500.00 Expedite Service 24-Hour 2-Hour 1-Hour EXPEDITED SERVICE requests may be submitted by: - E-mail to efilings@wvsos.gov - Fax - Walk in delivery 2 STANDARD PROCESSING (5-10 business days) SUBMIT COMPLETED FILING TO ONE OF THE BUSINESS CENTERS BELOW: INCLUDE PAYMENT: Be sure to enclose the correct filing fee with your filing. If paying by\ credit card, be sure to include the e-Payment Authorization form with your filing. Your filing will be rejected if the payment is not included or if the e-\ Payment Authorization form is not included if paying by credit card. Standard filing fees apply. STANDARD PROCESSING requests may be submitted by: - E-mail to CorpFilings@wvsos.gov - Fax - Walk in delivery (drop off service only filed within 5-10 business da\ ys) Martinsburg Office Eastern Panhandle Business Center 229 E. Martin Street Martinsburg, WV 25401 Phone: (304) 356-2654 Fax: (304) 260-4360 Hours: Mon. - Fri. 9:00a - 5:00p EST READ CAREFULLY BEFORE SUBMITTING - Expedite service is NOT AVAILABLE for the following filings: West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov Customer Order Request SUBMIT THIS COMPLETED FORM WITH YOUR FILING. Order Processing Requested*: * * * Expedite Processing Requires Additional Fees * * * \ Standard Processing** 24-HOUR Expedite *** 2-HOUR Expedite 1-HOUR Expedite Name of Entity: Return filing to: (Return Address) Contact Name: Phone: Return Delivery Options: Email or Fax options do not receive a copy via mail; must be ordered separately. Email to: Fax to: Hold for Pick Up UPS: Acct # Other (explain below): (additional $500.00 fee included) (additional $25.00 fee included) (additional $250.00 fee included) FedEx: Acct # Mail to Return Address above Order Description (include items being ordered and fee breakdown): * PLEASE NOTE: Original paperwork is kept by this office. Include a copy of the origin\ al filing if you want a file stamped copy returned to you at no extra charge. Certified copy requests are an additional $15 per certified copy being requested. Total Amount: Payment Method: Cash (Do Not mail cash) Pre-paid Acct #: Credit Card (Must attach e-Payment Authorization request form including payment information. ) Check/Money Order *"Processing" indicates the filing will be completed and registered in th\ e Secretary of State registration database. **Standard Processing applications received by E-MAIL or FAX must include the e-Payment Authorization form with credit card informati\ on. ***NOTE: Orders filed in person through any Secretary of State office location \ requesting the filing be processed will be assessed a 24-HOUR Expedite fee of $25.00 per order. (Avg. processing turnaround 5-10 business days ) Rev. 9/2018 Attach signed pre-paid slip. >> Tax Department filings including Sole Proprietorships, General Partnersh\ ips, and Associations >> Dissolution or Withdrawal of Corporation, Voluntary Association or Busi\ ness Trust Email to: CorpFilings@wvsos.gov Email to: eFilings@wvsos.gov IMPORTANT: To ensure expedited service, please mark “EXPEDITE” in\ a conspicuous place at the top of the service request. Please indicate method of delivery. 24-HOUR EXPEDITE SERVICE The Secretary of State offers a 24-hour expedite service on most busines\ s organization filings processed by this office. If you choose to utilize this service, please enclose with your filing the \ additional expedite fee. Please note that this expedite fee is in addition to the standard fee charged on each filing and/or ord\ er. You must mark the document with your “ 24-HOUR EXPEDITE” request. If using a cover letter, note that you are requesting 24-hour \ expedited service, and include your telephone number and return information. Each filing will be returned b\ y U.S.P.S. regular mail unless other arrangements are made. This office does not fax confirmation of a 24-hour expedite. The fee for 24-hour handling is $25.00 in addition to the usual fee for \ service. Please consult our fee schedules for the appropriate fee. If you require assistance, please contact this office.\ Time Constraints: Under most circumstances, each filing submitted receives same day fili\ ng date and may be picked up in the office by the end of the same business day. Filings to be mailed th\ e next business day if received by 2:00 pm of receipt date and no later than the 2nd business day if received after 2:00 pm. \ Expedite period begins when filing or service request is received in this office in acceptable fileable form . 2-HOUR EXPEDITE SERVICE The Secretary of State offers a 2-hour expedite service on most filings \ processed by this office. If you choose to utilize the 2-hour expedite service, please enclose with your filing an additional $\ 250.00 per filing and/or order. Please note that this expedite fee is in addition to the standard fee charged on each filing a\ nd/or order. Complete and submit the 2-hour customer order instruction form. If not using our order form, state cle\ arly in your cover letter that you are requesting 2-hour expedited service and include your telephone number and return informati\ on. Attach the order form or cover sheet to the top of your filing and submit to this office. Each filing will be returned\ by U.S.P.S. regular mail unless other arrangements are made. 1-HOUR EXPEDITE SERVICE The Secretary of State offers a 1-hour expedite service on most filings \ processed by this office. If you choose to utilize the 1-hour expedite service, please enclose with your filing an additional $\ 500.00 per filing and/or order. Please note that this expedite fee is in addition to the standard fee charged on each filing a\ nd/or order. Complete and submit the 1-hour customer order instruction form. If not using our order form, state cle\ arly in your cover letter that you are requesting 1-hour expedited service and include your telephone number and return informati\ on. Attach the order form or cover sheet to the top of your filing and submit to this office. Each filing will be returned\ by U.S.P.S. regular mail unless other arrangements are made. 1-Hour and 2-Hour Time Constraints: Each filing submitted for either 1-hour or 2-hour expedite receives same\ day filing date and will be acknowledged by fax or e-mail within expedite service t\ ime. Failure to indicate method of acknowledgement (fax or e-mail) or to provide a correct fax number or e-mail address m\ ay prevent the Secretary of State from acknowledging the filing of such documents. Filings may be picked up within the exped\ ite service period. Filings to be mailed will be mailed out no later than the next business day following receipt. Expedite per\ iod begins when filing or service request is received in this office in fileable form. The Secretary of State reserves the right to extend the expedite period \ in times of extreme volume, staff shortages or equipment malfunction. These extensions are \ few and will rarely extend more than a few hours. WV Secretary of State Expedite Guidelines Effective: 8-31-17 24-hour, 2-hour and 1-hour Expedite Service Guidelines MAC WARNER Secretary of State State Capitol Building Charleston, WV 25305 Phone: (304) 558-6000 Website: www.sos.wv.gov e-Payment Authorization Credit Card Number: Card Type: Service Type: Fax Mail E-mail Visa Mastercard Discover American Express Payment Information Storage Authorization Year: Entity Name: Name as it appears on the account Billing Address City State Zip Code Telephone Ext. I authorize the Secretary of State to store this payment information for\ future payment transactions processed by Secretary of State: Authorized Signature X (required) (optional) Date This document contains confidential financial information and will be pr\ operly shredded after payment has been processed by this office. Electronic storage of payment informa\ tion is only permitted by signed authorization below which may be retracted at any time by written reques\ t by the authorized party. Not to Exceed Amount: USD $ Date Month: V Code* * 3-digit number on back of VISA, MasterCard and Discover cards. 4-digit number on front right side of American Express card. NOTICE: For security and verification purposes, all credit card payments must in\ clude the 3- or 4-digit CVV2 code (V Code) number located on the credit card. Failure to include this code will result in \ the rejection of your filing or service request. Rev. 11/2017 West Virginia Secretary of State Business & Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov USE BLACK INK ONLY - DO NOT HIGHLIGHT Payment by Card (card holder name and billing address required below) Credit Card Expiration Date: Amount to Charge Card: USD $ Order Information (required) Card Holder Information: Payment Authorization I authorize the Secretary of State to bill an amount not to exceed the f\ ollowing to be charged to the above listed account(s): Authorized Signature X