Fillable CONSENT TO SERVICE TO THE COMMISSIONER OF FINANCIAL (California)

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CONSENT TO SERVICE TO THE COMMISSIONER OF FINANCIAL (California)

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STATE OF CALIFORNIA – DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION
CONSENT TO SERVICE
DFPI-260.102.8(b) (Register 2009, No. 39) (Rev. 11-20)
TO THE COMMISSIONER OF FINANCIAL PROTECTION
AND INNOVATION OF THE STATE OF CALIFORNIA
KNOW ALL MEN BY THESE PRESENTS:
That the undersigned, _____________________
(a corporation, partnership or
limited liability company organized under the laws of the State of ____________________),
OR
_____________________________________ (an individual),
OR
_____________________________________(other entity),
hereby irrevocably appoints the Commissioner of Financial Protection and Innovation of
the State of California, or the Commissioner's successor in office, to be the
undersigned’s attorney to receive service of any lawful process in any noncriminal suit,
action or proceeding against the undersigned, or the undersigned’s successor, executor,
or administrator which arises under the Corporate Securities Law of 1968, as amended,
or any rule or order thereunder after this consent has been filed, with the same force and
validity as if served personally on the undersigned.
For the purpose of compliance with the Corporate Securities Law of 1968, as
amended, of the State of California, notice of the service and a copy of the process
should be sent by registered or certified mail to the undersigned at the following address:
_____________________________________________________________________________
(Name and Address)
Dated: , 20____.
[Insert name of corporation,
partnership, limited liability company
or other entity]
By
Title
OR
[insert name of individual]
STATE OF CALIFORNIA – DEPARTMENT OF FINANCIAL PROTECTION AND INNOVATION
CONSENT TO SERVICE
DFPI-260.102.8(b) (Register 2009, No. 39) (Rev. 11-20) Page 2 of 2
ACKNOWLEDGMENT
State of California )
County of )
On__________________________________ (insert date) before me personally appeared
_________________________________________________________________________________
(insert name and title of the officer)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowledged to me that he/she/they executed
the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California
that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature (Seal)
Any certificate of acknowledgement taken in a foreign jurisdiction shall be sufficient in
the State of California if it is taken in accordance with the laws of the place where the
acknowledgement is made.
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CONSENT TO SERVICE TO THE COMMISSIONER OF FINANCIAL (California)

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Completed 28 April 2022

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