Statement Of Change Of Registered Office Or Registered Agent Or Both Form - Secretary Of State
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1STATEMENT OF CHANGE OF REGISTERED
Secretary of State Office
500 E Capitol Ave
FILE DATE
____________________
OFFICE OR REGISTERED AGENT OR BOTH
Pierre, SD 57501
RECEIPT NO ___________________
(605)773-4845
Please Type or Print Clearly in Ink
Original
Photocopy
Please submit one
and one
FILING FEE: $10
SECRETARY OF STATE
Make check payable to
1. Corporate ID and Name:
Clear Form
Search for Corporate ID, Name and Agent
Telephone # ____________________
2. The name of the registered agent on file ______________________________________________________________
(Old Registered Agent)
The name of the successor registered agent _________________________________________________________
(New Registered Agent)
3. If listing a Commercial Registered Agent, please state their identification number _____________________________
4. The address of the agent currently on file for this entity
(Old Registered Agent Address)
______________________________________________________________________________________________
Street Address (Required)
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address
City
State
ZIP+4
5. If the address has changed, list the new registered agent address
______________________________________________________________________________________________
Street Address or Rural Route Box Number in This State and
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address in This State, if Different from Street Address
City
State
ZIP+4
The address of its registered office and the address of the business office of its registered agent, as changed, must be identical. No person
may execute this report knowing it is false in any material respect. Any violation is subject to a civil penalty.
Dated ____________________________
______________________________________________
(Signature of an Authorized Person)
Email _____________________________________
______________________________________________
(Printed Name)
statementofchangeentity February 2011
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