State Form 26276 - Notice Of Change Of Registered Office Or Registered Agent 2012
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CONNIE LAWSON
NOTICE OF CHANGE OF REGISTERED OFFICE
SECRETARY OF STATE
OR REGISTERED AGENT (ALL ENTITIES)
CORPORATIONS DIVISION
302 W. Washington Street, Room E018
State Form 26276 (R9 / 4-12)
Indianapolis, Indiana 46204
Telephone: (317) 232-6576
Use 8 1/2" x 11" white paper for attachments.
Indiana Code 23-1-24-2 (for profit corporation)
INSTRUCTIONS:
Present original and one (1) copy to address in upper right corner of this form.
Indiana Code 23-17-6-2 (non-profit corporation)
Please TYPE or PRINT.
Please visit our office on the web at
NO FILING FEE
Date of incorporation / organization / admission (month, day, year)
Name of entity
Current registered office address (number and street, city, state, and ZIP code)
New registered office address (number and street, city, state, and ZIP code)
Current registered agent (type or print name)
New registered agent (type or print name)
STATEMENTS BY REGISTERED AGENT OR ENTITY
This statement is a representation that the new registered agent has consented to the appointment as registered agent, or
statement attached signed by registered agent giving consent to act as the new registered agent.
After the change or changes are made, the street address of this corporation's registered agent and the address of its registered
office will be identical.
The registered agent filing this statement of change of the registered agent's business street address has notified the represented
corporation in writing of the change, and the notification was manually signed or signed in facsimile.
IN WITNESS WHEREOF, the undersigned executes this notice and verifies, subject to the penalties of perjury, that the statements
contained herein are true, this ________________ day of ____________________________ , 20 _____ .
Signature
Title
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