Statement of Statutory Agent Appointment / Change

(Arizona Registered Agent Designation Template)

TABLE OF CONTENTS

1. Document Header
2. Recitals
3. Definitions
4. Operative Provisions
   4.1 Entity Information
   4.2 Current Statutory Agent (If Changing)
   4.3 Designation of New Statutory Agent
   4.4 Acceptance of Appointment by Statutory Agent
   4.5 Effectiveness
5. Representations & Warranties
6. Covenants
7. General Provisions
8. Execution Block

1. DOCUMENT HEADER

Statement of Statutory Agent Appointment / Change
Governing Statute:
• For Corporations: A.R.S. § 10-1507
• For LLCs: A.R.S. § 29-3115

Entity: [LEGAL NAME OF ENTITY] (the “Entity”)
Arizona Entity/File No.: [AZCC FILE NUMBER]
Entity Type: [Corporation / Limited Liability Company / Limited Partnership / Foreign Entity Qualified in AZ]
Effective Date: [DATE] (or “upon filing with the AZCC,” if no delayed effective date is requested)

2. RECITALS

A. The Entity is duly organized and in good standing under the laws of [STATE OF FORMATION] and is authorized (or is seeking authorization) to conduct business in the State of Arizona.

B. Pursuant to Arizona law, the Entity is required to maintain a statutory agent (“Statutory Agent”) with a physical street address in Arizona.

C. The Entity now desires to [DESIGNATE / CHANGE] its Statutory Agent as provided herein and to file this Statement with the Arizona Corporation Commission to effect such appointment.

3. DEFINITIONS

For purposes of this Statement, the following terms have the meanings set forth below. Any capitalized term not defined herein shall have the meaning ascribed to it in applicable Arizona statutes.

“AZCC” means the Arizona Corporation Commission, or any successor agency.

“Statutory Agent” means an individual who is a resident of the State of Arizona, or a business entity that is authorized to transact business in Arizona, and that has consented to accept service of process and official notices on behalf of the Entity, as required by A.R.S. § 10-1507 or A.R.S. § 29-3115, as applicable.

4. OPERATIVE PROVISIONS

4.1 Entity Information

a. Exact Legal Name of Entity: [ENTITY NAME]
b. Entity Type: [ENTITY TYPE]
c. Domestic State/Country: [STATE/COUNTRY]
d. Arizona File Number: [AZCC FILE NUMBER]
e. Principal Business Address: [STREET, CITY, STATE, ZIP, COUNTRY]

4.2 Current Statutory Agent (Complete ONLY if this is a CHANGE of agent)

a. Current Agent Name: [CURRENT AGENT NAME]
b. Current Agent Physical Address (No P.O. Box): [STREET, CITY, AZ ZIP]

4.3 Designation of New Statutory Agent

The Entity hereby designates the following individual or entity as its Statutory Agent in the State of Arizona:

a. Name of New Statutory Agent: [NEW AGENT NAME]
b. Agent Type: [___] Individual Arizona Resident ☐ Arizona-Authorized Business Entity
c. Physical Street Address in Arizona (No P.O. Box):
  [STREET ADDRESS]
  [CITY], Arizona [ZIP]
d. Mailing Address (if different): [MAILING ADDRESS OR “SAME AS PHYSICAL”]
e. Business Hours of Availability: [BUSINESS HOURS]

4.4 Acceptance of Appointment by Statutory Agent

The undersigned Statutory Agent hereby:
(i) Acknowledges and accepts the appointment as Statutory Agent for the Entity;
(ii) Confirms that the information set forth in Section 4.3 is accurate; and
(iii) Consents to serve and to comply with all statutory obligations, including maintaining a physical presence at the address stated above during normal business hours for the purpose of accepting service of process and official notices.

4.5 Effectiveness

This Statement shall become effective upon the later of (a) filing with the AZCC, or (b) [DELAYED EFFECTIVE DATE, not to exceed 30 days after filing] if a delayed effective date is specified.

5. REPRESENTATIONS & WARRANTIES

5.1 Authority. The Entity represents that the execution, delivery, and filing of this Statement have been duly authorized by all requisite corporate/organizational action.

5.2 Eligibility of Statutory Agent. The Entity and the Statutory Agent each represent that the Statutory Agent satisfies the statutory requirements of A.R.S. § 10-1507 or A.R.S. § 29-3115, as applicable.

5.3 Accuracy. Each signatory represents that the information contained herein is true, correct, and complete as of the date of execution.

6. COVENANTS

6.1 Continuous Agency. The Entity shall maintain a duly qualified Statutory Agent in Arizona at all times and shall promptly file any required statements of change should the agent or the agent’s address change.

6.2 Notice of Change. The Statutory Agent covenants to notify the Entity in writing at least [30] days prior to resigning pursuant to applicable statute, or immediately upon a change to the Agent’s address or qualification status.

7. GENERAL PROVISIONS

7.1 Governing Law. This Statement and any disputes arising hereunder shall be governed by and construed in accordance with the laws of the State of Arizona.

7.2 Severability. If any provision of this Statement is determined to be invalid or unenforceable under applicable law, such provision shall be severed, and the remainder of the Statement shall remain in full force and effect.

7.3 Entire Statement. This document constitutes the entire statement required for the appointment or change of a Statutory Agent in Arizona and supersedes any prior statement filed with respect to the subject matter herein.

7.4 Counterparts; Electronic Signatures. This Statement may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one instrument. Signatures transmitted by electronic means shall be deemed original signatures for all purposes.

8. EXECUTION BLOCK

8.1 ENTITY APPROVAL

Executed on [DATE]

____________________________________________________
[NAME OF AUTHORIZED SIGNATORY]
[Title (e.g., President, Manager, General Partner)]
For and on behalf of [ENTITY NAME]

8.2 STATUTORY AGENT ACCEPTANCE

I, [NEW AGENT NAME], hereby accept the appointment as Statutory Agent for [ENTITY NAME] and consent to serve in such capacity in accordance with Arizona law.

Executed on [DATE]

____________________________________________________
[NEW AGENT NAME]
(Signature of Statutory Agent or Authorized Representative)