Fillable ATHLETE AGENT NOTICE OF DECERTIFICATION This form may (Texas Secretary of State)

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ATHLETE AGENT NOTICE OF DECERTIFICATION This form may (Texas Secretary of State)

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ATHLETE AGENT NOTICE OF
DECERTIFICATION
Form #2511 Rev. 012/2011
Submit to:
SECRETARY OF STATE
Registrations Unit
P O Box 13550
Austin, TX 78711-3550
512-475-0775
512-475-2815 – Fax
Filing Fee: None
This form may be used to notify the secretary of state of an agent’s decertification as an agent by a
national professional sports association that has become final by the conclusion of the appeal process
provided by the association. Section 2051.109, Occupations Code, requires a registered athlete agent to
notify the secretary of state in writing not later than 30 days after the date of the athlete agent’s
decertification. Failure to notify the secretary of state as required by § 2051.109 may be grounds for
disciplinary action.
1. Name of Agent:
2. Agent ID
Number: OR
Registration
Number:
3. Principal
Business Address:
Street City State Zip
The following national professional sports associations have decertified me as an athlete agent:
Execution
Date:
Signature of athlete agent
Printed or typed name
Form 2511
1
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ATHLETE AGENT NOTICE OF DECERTIFICATION This form may (Texas Secretary of State)

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Completed 6 November 2020

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