This form must be type written or
State of Utah
computer generated.
Non-Refundable Processing Fee: $12.00
DEPARTMENT OF COMMERCE
Division of Corporations & Commercial Code
Print Form
Clear Form
Registration Information Change Form
Instructions
Important: Read instructions before completing form
Corporation
Limited Liability Company
Limited Partnership
Business Trust
1.
DBA
Limited Liability Partnership
Trademark
Entity File Number:
Registration Date:
2.
Entity Name:
Business Purpose:
Registered Agent:
Signature:
New Registered Agent must sign here after the form is printed
Registered Address:
Address: ______________________________________________________________
Utah Street Address Required,
______________________________________________________________
PO Boxes can be listed on the
City:
State:
Zip:
UT
line below the Street Address
Address: ______________________________________________________________
______________________________________________________________
Copy Address
City:
State:
Zip:
Name: ______________________________________________________
Add
3.
Address: ____________________________________________________
___________________________________________________
Remove
Remove
Copy Registered Agent Name
City: _____________________________ State: ____ Zip: ____________
Change
Copy Registered Agent Address
Signature
:
(if required)
Name: ______________________________________________________
Add
Address: ____________________________________________________
___________________________________________________
Remove
Remove
Copy Previous Name
City: _____________________________ State: ____ Zip: ____________
Change
Copy Previous Address
Signature
:
(if required)
Name: ______________________________________________________
Add
Address: ____________________________________________________
___________________________________________________
Remove
Remove
Copy Previous Name
City: _____________________________ State: ____ Zip: ____________
Change
Copy Previous Address
Signature
:
(if required)
Name: ______________________________________________________
Add
Address: ____________________________________________________
___________________________________________________
Remove
Remove
Copy Previous Name
City: _____________________________ State: ____ Zip: ____________
Change
Copy Previous Address
Signature
:
(if required)
Name: ______________________________________________________
Add
Address: ____________________________________________________
___________________________________________________
Remove
Remove
Copy Previous Name
City: _____________________________ State: ____ Zip: ____________
Change
Copy Previous Address
Signature
:
(if required)
Name: ______________________________________________________
Add
Under penalties of perjury and as an authorized authority, I declare that this statement of change(s), has been examined by me and is, to the best of my
Address: ____________________________________________________
knowledge and belief, true, correct and complete.
Remove
___________________________________________________
Remove
Copy Previous Name
Authorized party must sign here after the form is printed
City: _____________________________ State: ____ Zip: ____________
By
Title
Date
________________________________________________________________________________
______________________________________________________________
___________________________
Change
Copy Previous Address
Signature
:
Signature of Authorizing Party
(if required)
Under penalties of perjury and as an authorized authority, I declare that this statement of change(s), has been examined by me and is, to the best of my
knowledge and belief, true, correct and complete.
BY_________________________________________________________ Title___________________________ Date___________________
Signature of Authorizing Party
Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes,
the business entity physical address may be provided rather than the residential or private address of any individual affiliated with the entity.
Revised 10/05