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REQUIRED – check only one: Individual as statutory agent: I am signing on behalf of myself as the individual (natural person) resigning as statutory agent. The appointment as registered agent terminates (the resignation is effective) as of the thirty-first day after the date on which the Registered Agent.1. Insert the complete legal name of the business entity. 2. Insert the address of the business entity's principal place of business. 3. Complete and include this form with your paper submission. This information only will be used to communicate in writing about the submission, if needed. Written notice of the agent's resignation must be given to the limited liability company. Please indicate the name and address where. Submit the completed form in duplicate. The registered agent identified below submits to the Secretary of State the following Statement of Resignation.