Statement Of Resignation Of Registered Agent Form - Iowa Secretary Of State
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1
2STATEMENT OF
MATT SCHULTZ
RESIGNATION OF
Secretary of State
REGISTERED AGENT
State of Iowa
Read the instructions on the reverse before completing.
All items must be completed before the statement of resignation will be considered.
Statement
Name of Business Entity: _____________________________________________________________________
Principal Office Address: ______________________________________________________________________
Registered Office Address: ____________________________________________________________________
TO THE ABOVE NAMED BUSINESS ENTITY. Please be advised that notice is hereby given to said business entity that I,
______________________________________, registered agent appearing on the records of the secretary of state for the
business entity, do hereby resign as the registered agent effective ______________________. The registered office of the
business entity
is
is not discontinued at the same time.
Signature of Registered Agent: ___________________________________________________
Date: ___________________________
Certificate of Mailing
I, _________________________________, registered agent for ________________________________________________,
appearing on the records of the secretary of state, hereby certifies that on _______________________ I did send a copy of this
Statement of Resignation of Registered Agent by certified mail to the business entity
at the above principal place of business
and
to the above registered office, if the office was not discontinued.
Signature of Registered Agent: __________________________________________________
Date: ___________________________
635_0987
Rev. 1/11
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