State of North Carolina
Department of the Secretary of State
STATEMENT OF CHANGE OF MAILING ADDRESS
OF SURVIVING ENTITY*
1.
Pursuant to N.C.Gen. Stat. §§ 55-15-21(a)(4), 55A-11-09(d)(3) 55A-15-21(a)(4), 57C-7-12(a)(4) and
59-909(a)(4), as applicable, notice is hereby given by the undersigned business entity that its mailing
address has changed from
____________________________________________________________(mailing address previously
filed with the Secretary of State) to _____________________________________________________
________________________________________________________________(new mailing address).
2.
This Statement will be effective upon filing, unless a delayed date and/or time is specified:
__________________________________________________________________________________
This the ____ day of _____________, 20____.
____________________________________
Name of Entity
____________________________________
Signature
____________________________________
Type or Print Name and Title
NOTES:
1.
Filing fee is $10. This document and one exact or conformed copy of this Statement must be filed with the Secretary of State.
*
This form should only be used by the surviving entity in a merger to notify the Secretary of State of a change in its mailing address after
Articles of Merger or
an Application for Certificate of Withdrawal by Reason of Merger, Consolidation or Conversion have been filed. This form should not be used to change the registered
office address. A Statement of Change of Registered Office and/or Registered Agent should be used for that purpose.
(August 2000)
(Form N-13)
CORPORATIONS DIVISION
P. O. BOX 29622
RALEIGH, NC 27626-0622