FORM 2605—GENERAL INFORMATION (AUTOMOBILE CLUB AGENT TERMINATION NOTICE) THE

FORM 2605—GENERAL INFORMATION (AUTOMOBILE CLUB AGENT TERMINATION NOTICE) THE

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OFFICE OF THE SECRETARY OF STATE

Form 2605—General Information

(Automobile Club Agent Termination Notice)

The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant code provisions. This form and the information provided are not substitutes for the advice and services of an attorney.

Commentary

Automobile Clubs are governed by Chapter 722 of the Texas Transportation Code (the “Automobile Club Services Act”) and the secretary of state’s administrative rules found in 1 Texas Administrative Code Chapter 75.

An automobile club must notify the secretary of state no later than the 30^th day after the date the automobile club terminates an agent by submitting this form to the secretary of state.

Instructions for Form

• Automobile Club Information: State the name of the automobile club.

• Agent Information: Include the full legal name, date of birth, last known address, social security number and gender of the terminated agent.

• Execution: An authorized representative for the automobile club must sign the form.

• Delivery Instructions: The form may be mailed to Registrations Unit, P.O. Box 13193, Austin, Texas 78711-3193 or delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701.

Revised 05/2019

Form #2605 Rev. 05/2019 Submit to: SECRETARY OF STATE Registrations Unit P O Box 13193 Austin, TX 78711-3193 512-475-0775 512-475-2815 - Fax Filing Fee: None

AUTOMOBILE CLUB AGENT TERMINATION NOTICE

This space reserved for office use

Registration Number:

     

Automobile Club Information

Name:

     

Agent Information

Name:

     

Date of Birth:

     

Last Known Address:

     

     

  

     

Street

City

State

Zip

Social Security Number:

   

-

  

-

    

Gender:

Male

Female

Execution

Date:

     

Signature of authorized person FOR AUTOMOBILE CLUB

     

Printed or Typed Name

Tags: (automobile club, termination, (automobile, notice), agent, information, 2605—general

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