STATEMENT OF CHANGE OR DESIGNATION OF REGISTERED AGENT

(Connecticut Domestic or Foreign Filing Entity)

[// GUIDANCE: This template is designed to satisfy Connecticut Secretary of the State requirements for changing or appointing a registered agent for a corporation, LLC, LP, LLP, or statutory trust. It is not the official state form; attach or transpose its content to the Secretary’s web-filing or paper form as required. Retain this executed instrument in the entity’s minute book for evidentiary purposes.]

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants
6. General Provisions
7. Execution Block & Agent Consent

1. DOCUMENT HEADER

1.1 Title. Statement of Change or Designation of Registered Agent (the “Statement”).

1.2 Filing Entity.
• Legal Name: [ENTITY LEGAL NAME]
• Entity Type: [Corporation / LLC / LP / LLP / Statutory Trust]
• Jurisdiction of Formation: [STATE]
• Connecticut Secretary of the State (“SOTS”) ID #: [SOTS ID]

1.3 Effective Date. The Statement shall become effective on the date and time of filing with the Connecticut SOTS or on [DELAYED EFFECTIVE DATE, if any], not to exceed ninety (90) days after filing.

1.4 Governing Law & Forum. This Statement is governed by Connecticut corporate and entity law. Any dispute arising hereunder shall be heard exclusively in the Connecticut Business Court or other court of competent jurisdiction located in Hartford County, Connecticut.

2. DEFINITIONS

“Agent” means the individual or business entity appointed below to receive service of process on behalf of the Entity.

“Registered Office” means the physical street address in Connecticut where the Agent maintains a business office.

“Secretary” means the Connecticut Secretary of the State.

3. OPERATIVE PROVISIONS

3.1 Revocation of Prior Agent (If Applicable). Effective as of the Effective Date, the Entity hereby revokes the authority of its prior registered agent, [NAME OF PRIOR AGENT], and releases said agent from future obligations arising solely from its former registered-agent capacity.

3.2 Appointment of New Agent. The Entity designates and appoints the following as its exclusive registered agent in Connecticut (the “New Agent”):

• Name of Agent: [FULL LEGAL NAME OF NEW AGENT]
• Capacity: ☐ Individual CT Resident  ☐ Connecticut-qualified Business Entity
• Connecticut Business Entity ID # (if applicable): [ID #]

3.3 Registered Office.
• Street Address (no P.O. Box): [NUMBER, STREET, SUITE]
• City/Town: [CITY], CT [ZIP]
• Mailing Address (if different): [ADDRESS OR “SAME”]

3.4 Consent of Agent. Pursuant to Connecticut law, the New Agent has executed the Consent in Section 7, affirming acceptance of the appointment and understanding of the duties imposed by statute.

3.5 Continuity of Service. The New Agent shall serve until a successor registered agent is appointed and a corresponding filing is accepted by the Secretary.

4. REPRESENTATIONS & WARRANTIES

4.1 Entity Representations. The undersigned authorized person represents and warrants on behalf of the Entity that:
a. The information contained in this Statement is accurate and complete.
b. The Entity is in good standing or will take all necessary actions to restore good standing with the Secretary.

4.2 Agent Representations. By executing the Consent, the New Agent represents and warrants that:
a. If an individual, the Agent is a resident of the State of Connecticut and is at least eighteen (18) years of age.
b. If an entity, the Agent is organized under Connecticut law or authorized to transact business in Connecticut.
c. The Registered Office is a physical location where the Agent is available during normal business hours to accept service of process.

5. COVENANTS

5.1 Maintenance of Current Information. The Entity shall promptly file with the Secretary any future change to the Agent’s name, address, or status as required by law.

5.2 Cooperation. The Entity and the Agent shall cooperate in good faith regarding any legal process, governmental inquiry, or correspondence received at the Registered Office.

6. GENERAL PROVISIONS

6.1 Amendments. This Statement may be amended only by a subsequent writing executed with the same formalities and duly filed with the Secretary.

6.2 Severability. If any provision of this Statement is held unenforceable, the remaining provisions shall remain in full force and effect.

6.3 Electronic Signatures. Signatures transmitted electronically (including via PDF or state e-filing platform) shall be deemed original and enforceable.

7. EXECUTION BLOCK & AGENT CONSENT

Executed on this ___ day of _, 20

7.1 ENTITY SIGNATURE

[// GUIDANCE: Verify signer’s authority—e.g., President for corporations, Manager for manager-managed LLC, General Partner for LP.]

7.2 AGENT CONSENT AND ACCEPTANCE

By signing below, the undersigned New Agent hereby: (i) consents to serve as registered agent for the above-named Entity; (ii) acknowledges and accepts the duties imposed by Connecticut law, including the obligation to forward to the Entity any process, notice, or demand served upon the Agent; and (iii) affirms that the information provided in Section 3.3 is true and correct.

[// GUIDANCE: For a corporate or LLC Agent, an authorized officer or manager must sign on its behalf.]

FILING INSTRUCTIONS (Non-substantive; remove prior to submission if desired)

1. Confirm that the Agent’s street address is a Connecticut location and not a P.O. Box.
2. If the Agent is an entity, be sure it is active and in good standing with the Secretary.
3. File the Statement electronically through the Connecticut Secretary of the State CONCORD system, or submit thepaper form “Change of Agent/Office” with the required state filing fee.
4. Retain stamped/acknowledged copy in the Entity’s minute book.
5. Update any ancillary registrations (e.g., local business licenses, federal filings) to reflect the new agent information.

[// GUIDANCE: Connecticut charges separate filing fees for different entity types; verify current fee schedule on the Secretary’s website before submission.]

END OF TEMPLATE