Statement Form Of Correction Correcting The Registered Agent Information
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1
2Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Statement of Correction
Correcting the Registered Agent Information
filed pursuant to § 7-90-305 and § 7-90-703 of the Colorado Revised Statutes (C.R.S.)
1. The entity ID number and the entity name, or, if the entity does not have an entity name, the true name are
Entity ID number
__________________________
(Colorado Secretary of State ID number)
Entity name or True name
______________________________________________________.
2. The document number of the filed document that is corrected is ___________________________________.
3.
(If applicable, adopt the following statement by marking the box and enter all changes.)
The registered agent name as stated in the document identified above is incorrect.
Such name, as corrected, is
Name
(if an individual)
____________________ ______________ ______________ ____.
(Last)
(First)
(Middle)
(Suffix)
OR
(if an entity)
______________________________________________________.
(Caution: Do not provide both an individual and an entity name.)
(The following statement is adopted by marking the box.)
The person appointed as registered agent has consented to being so appointed.
4.
(If applicable, adopt the following statement by marking the box and enter all changes.)
The registered agent address as stated in the document identified above is incorrect.
Such address, as corrected, is
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________
CO
____________________.
(City)
(State)
(ZIP Code)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________
CO
____________________.
(City)
(State)
(ZIP Code)
5.
(If applicable, adopt the following statement by marking the box.)
Notice of the correction has been delivered to the entity.
CORRECT_RA
Page 1 of 2
Rev. 10/07/2008
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