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Resignation Of Registered Agent And Discontinuance Of Registered Office Of A South Carolina Or Foreign Corporation

This is a resignation of a registered agent and discontinuance of a registered office in South Carolina. The form provided here is simply a sample of what the actual Form DOM12 looks like.

STATE OF SOUTH CAROLINA
SECRETARY OF STATE

RESIGNATION OF REGISTERED AGENT AND DISCONTINUANCE OF REGISTERED OFFICE OF A SOUTH CAROLINA OR FOREIGN CORPORATION

PLEASE TYPE OR PRINT IN BLACK INK

Pursuant to Sections 33-5-103 and 33-15-109 of the South Carolina Code of Laws, as amended, the undersigned hereby submits the following:

1. The name of the Corporation that is affected by this document is

The date of Incorporation is _____________________________

2. [____] That the undersigned resigns as the registered agent of the above named corporation effective the 31st day after the date on which this document is filed in the Office of the Secretary of State.

3. [____] That the above named corporation's registered office, which is the business office of the registered agent, is discontinued, effective the 31st day after the date on which this document is filed in the Office of the Secretary of State.

Date: ______________________________________

______________________________________
Signature

______________________________________
Type or Print Name


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INSTRUCTIONS FOR FILLING OUT THIS FORM
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1. Three copies of this document, the original and either two duplicate originals or two conformed copies must be filed.

2. Filing fee (payable to the Secretary of State at the time of filing this document):

Agent's Statement of Resignation $ 3.00
Discontinuance of Registered Office 2.00
Total $ 5.00

Return to: Secretary of State
P.O. Box 11350
Columbia, SC 29211

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