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Change of Statutory Agent (Connecticut)

This is a change of a statutory agent for a domestic limited liability company in Connecticut. The form provided here is simply a sample of what the actual Form LLC 401 looks like.

CHANGE OF STATUTORY AGENT
DOMESTIC LIMITED LIABILITY COMPANY

Office of the Secretary of the State
30 Trinity Street / P.O. Box 150470 / Hartford, CT 06115-0470 / Rev. 12/1999


1. NAME OF LIMITED LIABILITY COMPANY:

__________________________________

2. APPOINTMENT OF NEW STATUTORY AGENT:

__________________________________

Print or type name of agent: __________________________________

Business address: (complete address only, P.O.Box is not acceptable)

__________________________________

__________________________________

Residence address: (complete address only, P.O.
Box is not acceptable)

__________________________________

__________________________________

Acceptance of appointment


__________________________________
Signature of agent

3. EXECUTION:

Dated this _________________day of ____________________, 20_____.

__________________________________
Print or type name of signatory

__________________________________
Capacity of signatory

__________________________________
Signature


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INSTRUCTIONS FOR FILLING OUT THIS FORM
-------------------

Instructions correspond with numbered entries on the form

1. NAME OF LIMITED LIABILITY COMPANY: Please provide the complete name of the Limited Liability Company as it appears on the records of the Secretary of the State.

2. APPOINTMENT OF NEW AGENT: A Limited Liability Company may not be its own agent. Please provide the name of the new statutory agent. The agent may be a natural person who is a resident of Connecticut, a Connecticut corporation or a foreign corporation which has obtained a Certificate of Authority to transact business in Connecticut, a Connecticut Limited Liability Company, or a Foreign Limited Liability Company which is registered to transact business in this state. If the agent is a natural person, such person must provide the complete street address of his or her business and residence. If the agent is a corporation, it must provide the address of its principal office in the block designated for "Business address" and the person signing on its behalf must include his or her title on the signature line. The agent must sign accepting the appointment.

3. EXECUTION: The signatory must print or type his or her full legal name and capacity in addition to an original signature. Note: the execution constitutes a statement made under the penalties of false statement that the information provided in the document is true.

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