Statement Of Change Of Resident Agent Form

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Filing Fee: $20.00
ID Number: ____________
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Office of the Secretary of State
Corporations Division
148 W. River Street
Providence, Rhode Island 02904-2615
LIMITED LIABILITY COMPANY
__________________
STATEMENT OF CHANGE OF RESIDENT AGENT
Pursuant to the provisions of Section 7-16-11 of the General Laws, 1956, as amended, the undersigned authorizes a
change of its resident agent and the address of its resident agent in the state of Rhode Island as follows:
1. The name of the limited liability company is:
2. The address of the resident agent as PRESENTLY shown in the records on file with the Rhode Island Secretary of
State is:
3. The NEW address of the resident agent is:
4. The name of the resident agent as PRESENTLY shown in the records on file with the Rhode Island Secretary of
State is:
5. The name of the NEW resident agent is:
6. The appointment of a new resident agent and the change of address of the resident agent, as the case may be, shall
become effective upon the filing of this statement.
Under penalty of perjury, I declare that the information
contained herein is true and correct.
Date:
Print Name of Limited Liability Company
Signature of Authorized Person
Form No. 642
Revised: 12/05

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