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Nt and Office Information Name Telephone Street Address City State Zip Code State Zip Code Mailing Address City I accept this appointment and confirm that I am familiar with and accept the obligations of the position as set forth in Section 106.022, F.S. I also understand that I may resign this appointment by executing a written statement of resignation and filing it with the applicable filing officer. Signature of Registered Agent Date Former Registered Agent and Office Information (.

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