Wyoming Domestic LLC Consent to Registered Agent Form

The following form has to be submitted along with the Articles of Organization form that was used when the original application for a new Limited Liability Company (LLC) in Wyoming was made.Download

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Wyoming Secretary of State 	
 State Capitol Building, Room 110 
   200 West 24	th Street  
  Cheyenne, W Y 82002-0020 
  Ph. 307.777.7311 
  Fax 307.777.5339 
  Email: Business@ wyo.gov	
 	
RAConsent  – Revised  12/11 	
 
Consent to Appointment  by Registered Agent  
 	
 
 
I,                                                                                                              \
                    , registered office located at   
    (name of registered agent)  
       
              voluntarily consent to serve   
 
                               
       	
*  (registered office  physical address, city, state & zip)  	
 
as the  registered agent for                                                                            \
                                                             	                                                            	 	
                                                              (nam e of business entity)  
 
I hereby certify that I am in compliance with the requirements of W.S. 17- 28-101 through W.S. 17- 28-111.   
 
 
Signature:__________________________________________   Date: 
                                       ( Shall be executed by  the registered agent .)                      (mm/dd/yyyy)  
 
Print Name:       Daytime Phone : 
 
Title:        Email: 
 
Registered Agent  Mailing Address 
 (if different than above) :	
 	
 
 
*If this is a new address,  complete the following: 
 
Previous Registered Office (s):  
I  hereby  certify that:  
•   After the changes are made, the street address of  my registered office and business office will be identical.  
•   This change affects every entity served by  me and  I have notified each entity of the registered office change.  
•   I certify t hat the above information is correct and I am in compliance with the requirements of W.S. 17 -28- 101 through   
W.S. 17 -28- 111.   
 
 
Signature:  __________________________________________   Date: 
                                       ( Shall be executed by  the registered agent .)                    (mm/dd/yyyy)   
 Checklist	 	
          Submit o ne originally signed  consent to appointment  and one exact photocopy.