Fillable Arkansas Secretary of State (State of Arkansas)

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Arkansas Secretary of State (State of Arkansas)

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U.S.A. forms for State of Arkansas

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$50.00 Filing FEE made payable to the Arkansas Secretary of State CRA-R Rev. 11/18
COMMERCIAL REGISTERED AGENT LISTING STATEMENT
(Please type or print)
1. Name of individual or entity: ______________________________________________________________________________
Fictitious name: ________________________________________________________________________________________
2. Jurisdiction: ___________________________________ If entity, type of entity: __________________________________
3. Street address of registered agent for service of process (In Arkansas):________________________________________
Street Address
_______________________________________________________________________________________________________
Street Address Line 2 City, State Zip
4. Mailing Address: ________________________________________________________________________________________
Mailing Address Line 1
_______________________________________________________________________________________________________
Mailing Address Line 2 City, State Zip
5. Information regarding alternate means of accepting service of process:_________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
The above referenced individual or entity intends to be in the business of serving as a Commercial
Registered Agent in Arkansas in accordance with Act 15 of 2007.
I understand that knowingly signing a false document with the intent to file with the Arkansas
Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or
imprisonment up to 30 days.
Executed this _______________ day of ___________________, ___________________.
___________________________________________________
Signature of Authorized Individual
_______ __________________________________________
Printed Name and Title of Authorized Individual
Arkansas Secretary of State
1401 W. Capitol, Suite 250, Little Rock, AR 72201
John Thurston
501-682-3409 • www.sos.arkansas.gov
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Arkansas Secretary of State (State of Arkansas)

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Completed 23 May 2022

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