Statement Of Change Of Resident Agent Form Page 2
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1
2INSTRUCTIONS FOR FILING
1. Prior to submitting the statement for filing, it is recommended that you call the Corporations Division at (401) 222-
3040 to verify that the information required in Items 2 and 4 of the preceding form currently appears in the records of
the Secretary of State. If the information is inconsistent with the records of this office, the statement will be returned.
2. It is required by law to provide a street address in item 3 of the preceding form in order to provide the public with
notice of a physical location at which process, notice or demand required or permitted by law may be served on the
resident agent. A statement submitted with a post office box address only will not be accepted for filing.
3. The statement must be signed on behalf of the limited liability company by an authorized person which authorizes the
change.
4. The fee for filing the Statement of Change of Resident Agent is $20.00, and payment should be made payable to the
Rhode Island Secretary of State.
NOTE: If a resident agent’s address is changed to another address in this state, the resident agent may
change the address by completing the statement below instead of the preceding form. This statement must
be signed by the resident agent, or on the resident agent’s behalf, and submitted for filing, without fee. Again,
it is recommended that you call the Corporations Division prior to submitting the Statement to verify that the
information required in item 2 below currently appears in the records of the Secretary of State. As required by
law, you must provide a street address in item 3 below.
--------------------------------------------------------------
No Filing Fee
ID Number: ____________
STATEMENT OF CHANGE OF ADDRESS
OF THE RESIDENT AGENT
Pursuant to the provisions of Section 7-16-11(c)(1) of the General Laws, 1956, as amended, the undersigned resident
agent, or the person signing on behalf of the resident agent, submits the following statement for the purpose of changing
the agent’s address within this state:
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 change of address of the resident agent shall become effective upon the filing of this statement, or on
(a date not prior to, nor more than 30 days after, the filing of this Statement)
Under penalty of perjury, I declare that the information
contained herein is true and correct.
Date:
Print Name of Resident Agent
Signature
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