Form Bca 5.10/5.20 - Statement Of Change Of Registered Agent And/or Registered Office - 2003 Page 2

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7. If authorized by the board of directors, sign here. See Note 5 below.
The undersigned corporation has caused this statement to be signed by a duly authorized officer who affirms, under
penalties of perjury, that the facts stated herein are true and correct.
Dated _______________________________ , _____
________________________________________________
Month & Day
Year
Exact Name of Corporation
______________________________________
Any Authorized Officer’s Signature
______________________________________
Name and Title (type or print)
If change of registered office by registered agent, sign here. See Note 6 below.
The undersigned, under penalties of perjury, affirms that the facts stated herein are true and correct.
Dated _______________________________ , _____
________________________________________________
Month & Day
Year
Signature of Registered Agent of Record
________________________________________________
Name (type or print)
If Registered Agent is a corporation,
Name and Title of officer who is signing on its behalf.
NOTES
1. The registered office may, but need not be, the same as the principal office of the corporation. However, the registered
office and the office address of the registered agent must be the same.
2. The registered office must include a street or road address (P.O. Box alone is unacceptable).
3. A corporation cannot act as its own registered agent.
4. If the registered office is changed from one county to another, the corporation must file with the Recorder of Deeds of
the new county a certified copy of the Articles of Incorporation and a certified copy of the Statement of Change of
Registered Office. Such certified copies may be obtained ONLY from the Secretary of State.
5. Any change of registered agent must be by resolution adopted by the board of directors. This statement must be signed
by a duly authorized officer.
6. The registered agent may report a change of the registered office of the corporation for which he/she is a registered
agent. When the agent reports such a change, this statement must be signed by the registered agent. If a corporation
is acting as the registered agent, a duly authorized officer of such corporation must sign this statement.
Printed by authority of the State of Illinois - 6/06 - 20M - C-135.17

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