Statutory Trust Instructions
Wyoming Secretary of State
Herschler Building East, Suite 101 122 W 25th Street Cheyenne, WY 82002-0020
307.777.7311 [email protected]
ST-CertificateTrustInstruction – Revised May 2022
Before Filing Please Note __________________________________________________________________
Filing fee of $100.00. Make check or money order payable to Wyoming Secretary of State.
The name of the statutory trust need not include the words “statutory trust.” If the name
includes the word “trust” it must immediately follow the word “statutory.”
Under the circumstance specified in W.S. 17-28-104(e), an email address is required.
An annual report will be due on or before January 2 each year. If not paid within thirty
(30) days from the due date the entity will become delinquent, increasing the fee to $200. If not
filed by April 1, the entity will be subject to dissolution/revocation.
Please review the form prior to submission. The Secretary of State’s Office is unable to
process incomplete forms.
You’re Ready to Mail in Your Documents!
P
rocessing time is up to 15 business days following the date of receipt in our office
.
W
yoming statutes do not allow for expedited filing at this time. Your filing will be processed in the
order it is received.
You can visit our website at http://wyobiz.wyo.gov
to see what day is currently being processed.
A
dditional Contact Information ____________________________________________________________
Department of Rev
enue (Sales and Use Tax Information)
o Ph. 307.777.5200 OR https://revenue.state.wy.us/
Department of Workforce Services (Workers’ Compensation or Unemployment Insurance)
o Ph. 307.777.8650 OR http://www.wyomingworkforce.org/
Internal Revenue Service (Tax ID Information)
o https://www.irs.gov/Filing
For Office Use Only
Wyoming Secretary of State
Herschler Building East, Suite 101
122 W 25th Street
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Email: [email protected]
ST-CertificateTrust - Revised June 2021
Statutory Trust
Certificate of Trust
1. Name of Statutory Trust:
2. Name and address of at least one (1) of the trustees authorized to manage the statutory trust:
Name: Address:
3. Name and physical address of its registered agent:
(The registered agent may be an individual resident in Wyoming or a domestic or foreign business entity authorized to transact business in
Wyoming. The registered agent must
have a physical address in Wyoming. If the registered office includes a suite number, it must be
included in the registered office address. A Drop Box is not acceptable. A PO Box is acceptable if listed in addition to a physical address.)
Name:
Address:
(If mail is received at a Post Office Box, please list above in addition to the physical address.)
4. Mailing address of the statutory trust:
5. Principal office address:
(The name of the statutory trust need not include the words “statutory trust.” If the name includes the word “trust” it must immediately
follow the word “statutory.”)
ST-CertificateTrust - Revised June 2021
6. Future effective date or time of this certificate if it is NOT to be effective upon the filing of this
certificate:
(Date – mm/d
d/yyyy)
8. Execution:
Date:
(mm/dd/yyyy)
Date:
(mm/dd/yyyy)
Date:
(mm/dd/yyyy)
Trustee Signature: _________________________________________
Print Name:
Trustee Signature: _________________________________________
Print Name:
Trustee Signature: _________________________________________
Print Name:
Contact Person:
Daytime Phone Number:
Email:
(An email address is required. Email(s) provided will receive
important reminders, notices and filing evidence.)
Note:
An annual report will be due on or before January 2 each year. If not paid within thirty (30) days from the due
date
the entity will become delinquent, increasing the annual report fee to $200. If not filed by April 1, the entity will
be subject to dissolution/revocation.
7. Certification. (Please check the box to complete the required certification.)
I consent on behalf of the business entity to accept electronic service of process at the required email address
provided on the form under the circumstances specified in W.S. 17-28-104(e).
Wyoming Secretary of State
Herschler Building East, Suite 101
122 W 25th Street
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Email: Business@wyo.gov
Consent to Appointment by Registered Agent
I, , registered office located at
(name of registered agent)
voluntarily consent to serve
*(registered office physical address, city, state, & zip)
as the registered agent for
(name of business entity)
I hereby certify that I am in compliance with the requirements of W.S. 17-28-101 through W.S. 17-28-111.
Signature:__________________________________________ Date:
(Shall be executed by the registered agent.) (mm/dd/yyyy)
Print Name: Daytime Phone:
Title: Email:
Registered Agent Mailing Address
(if different than above):
(An email address is required. Email(s) provided will receive
important reminders, notices and filing evidence.)
RAConsent – Revised December 2021
IMPORTANT: If you are an existing registered agent and your existing address on record does not match what
is provided on this form, a Registered Agent Information Update form is also required.
