SECRETARY OF STATE
File Date _______________
STATE CAPITOL
STATEMENT OF CHANGE OF REGISTERED OFFICE
Receipt No. _____________
500 E. CAPITOL
OR REGISTERED AGENT, OR BOTH
PIERRE, S.D. 57501-5077
605-773-4845
Clear Form
FILING FEE: $10 In addition to annual report fee
Print
Pursuant to the provisions of the South Dakota Business Corporation Act, the undersigned corporation submits the
following statement for the purpose of changing its registered office and/or its registered agent in the state of South
Dakota.
1. The name of the corporation is _____________________________________________________________________
2. The street address, or a statement that there is no street address, of its current registered office __________________
____________________________________________________________________ ZIP + 4 __________________
3. The new address to which the registered office is to be changed. A PO box number can be used for mailing
but a street address, or a statement that there is no street address, if street addresses have not been assigned,
or the RR address, must also be included. ____________________________________________________________
____________________________________________________________________ ZIP + 4 __________________
4. The name of its current registered agent is ____________________________________________________________
5. The name of its new registered agent is * _____________________________________________________________
*The Consent of Registered Agent below must be completed by the new agent.
6. The address of its registered office and the address of the business office of its registered agent, as changed, will be
identical.
The statement may be signed by any authorized officer of the corporation.
Dated ____________________________
_______________________________________________
Signature
______________________________________________
Printed Name
_______________________________________________
Title
CONSENT OF APPOINTMENT BY THE REGISTERED AGENT
I, ___________________________________________________________ ,hereby give my consent to serve as the
(name of registered agent)
registered agent for ____________________________________________________________________________
(corporate name)
Dated _______________________________________
_________________________________________
(signature)
statementofchange July 2005