Fill and Sign the Registered Church Form

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:       Certificate of Revocation of Appointment of Registered Church Agent Page 1 of 1