I, [NAME], hereby consent to serve as Registered Agent in the state of [STATE], for [CORPORATION'S NAME], a [STATE OF INCORPORATION] corporation.

I understand that as agent it will be my responsibility to accept and forward service of process and all mail to the corporation. In the event of my resignation or of any change in the Registered Office address, I will notify the Secretary of State immediately.

Date:

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Signature of Registered Agent [INCLUDE TITLE IF

SIGNING FOR CORPORATE REGISTERED AGENT]