Notice Form Of Change Of Registered Office/registered Agent Page 2
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1
2INSTRUCTIONS
This form is used for changing the registered office address and/or registered agent listed with the Office of the
Secretary of State.
Retain the original signed copy of this document for your records and submit a legible photocopy for filing with the
Secretary of State.
Line 1 Fill in the name of the entity exactly as it appears in the original organizing document or subsequent
amendments.
Line 2 The registered office address is the legal location for service of process or notice(s) sent to the entity. If you
are using this form to change the registered office address, list the new address on this line. The registered
office address must be a complete street address, or rural route AND rural box number. A post office box
number is not acceptable. This MUST be a Minnesota address.
Line 3 The registered agent accepts service of process or notice(s) sent to the entity. The registered agent must be a
person residing in Minnesota, a Minnesota entity, or a foreign entity authorized to do business in this state.
Do not list your entity name on this line because a entity may not act as its own agent.
Sign the form
Minnesota Statutes require that an officer, representative, or authorized agent sign the form. (The signing party must
indicate on the document that they are acting as the agent of the person(s) whose signature would be required and that they
have been authorized to sign on behalf of that person(s).)
Contact person
Print the name and telephone number of the person who may be contacted if there are any questions about
this filing.
FILE IN-PERSON OR MAIL TO:
Minnesota Secretary of State - Business Services
Retirement Systems of Minnesota Building
60 Empire Drive, Suite 100
St Paul, MN 55103
(Staffed 8:00 - 4:00, Monday - Friday, excluding holidays)
To obtain a copy of a form you can go to our web site at , or contact us between 9:00am to 4:00pm,
Monday through Friday at (651) 296-2803 or toll free 1-877-551-6767.
All of the information on this form is public. Minnesota law requires certain information to be provided for this type of
filing. If that information is not included, your document may be returned unfiled. This document can be made available in
alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and
hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to
(651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation,
national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in
employment or the provision of service.
ChangeOfRegisteredOfficeAgentRev.08-05-10
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