Form For Statement Of Change Of Business Mailing Address

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File Number: _________________
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STATEMENT OF CHANGE OF BUSINESS MAILING ADDRESS
(see reverse for instructions)
The entity identified below submits to the Secretary of State the following statement for the
purpose of changing its business mailing address.
1. The name of the business entity is: ______________________________________________
2. The business mailing address is currently on file as:
__________________________________________________________________________
3. The business mailing address is to be changed to:
__________________________________________________________________________
4. Change of address is effective:
________________
OR
Upon Receipt
(Date)
Signed: ____________________________________________
Printed Name: _______________________________________
Capacity: ___________________________________________
Dated: _____________________________________________
FILE ONE COPY
NO FEE REQUIRED
g:\corp\forms\miscforms\change_address.pmd

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