Form F0120 - Application For Appointment Of Registered Agent 2009
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111 F0120 - Page 1 of 1
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136
(601) 359-1633
Application for Appointment of Registered Agent
1. Name of the Limited Liability Company
Business email address________________________________
2. It was organized under the laws of the state or other jurisdiction of
3. Name and Street Address of the Registered Agent and Registered Office are
Name
Physical
Address
P.O. Box
City, State, ZIP5, ZIP4
is designated and appointed registered agent of this Limited Liability Company in the State of Mississippi upon whom service of process
against this Limited Liability Company may be had in the event of any suit against this Limited Liability Company in said State; and that
all prior designations and appointments of registered agents, if any, be and the same hereby revoked.
Witness my signature, and the SEAL of said Company, this the
day of
(year)
(
By:
Signature
Please keep writing within blocks)
Printed Name
Title
The undersigned hereby accepts the above description and appointment of registered agent for service of process
Dated in
Mississippi, the
day of
(year)
(
Signature
Please keep writing within blocks)
of Registered
Agent
Rev. 06/09
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