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.