Forn Llc 9 - Statement Of Change Of Registered Agent And/or Registered Office Of Limited Liability Company
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State of Missouri
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Matt Blunt, Secretary of State
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Corporations Division
P.O. Box 778 / 600 W. Main Street, Rm 322
Jefferson City, MO 65102
Statement of Change of Registered Agent and/or
Registered Office of Limited Liability Company
(Submit in duplicate with filing fee of $10)
Instructions
This form is to be used by a Limited Liability Company to change either or both the name of its registered agent
and/or the address of its existing registered agent. The registered office may be the same as the place of business
of the Limited Liability Company. The address of the Limited Liability Company’s registered office and the
address of the business office of its registered agent must be identical. The Limited Liability Company cannot act
as its own registered agent. If the agent is a corporation, this form must be executed by an authorized person(s).
Any subsequent change in the registered office or agent must be immediately reported to the Secretary of State.
Charter No.__________________________
1. The name of the Limited Liability Company is:
________________________________________________________________________________________________________
2. The address, including street number if any, of its registered office before this date change is:
________________________________________________________________________________________________________
3. Its registered office (including street number, if any change is to be made) is hereby changed to:
________________________________________________________________________________________________________
Address
(P.O. Box may only be used in conjunction with a physical street address)
City/State/Zip
4. The name of its registered agent before this change is:
________________________________________________________________________________________________________
5. The name of the new registered agent is: _______________________________________________________________________
Authorized signature of new registered agent must appear below:
________________________________________________________________________________________________________
(May attach separate originally executed written consent to this form in lieu of this signature)
6.
Such change was authorized by resolution duly adopted by the limited liability company.
In affirmation thereof, the facts stated are true:
____________________________________________________________________________________________________________
(Authorized Signature)
(Printed Name)
(Date)
____________________________________________________________________________________________________________
(Authorized Signature)
(Printed Name)
(Date)
LLC 9 (12/02)
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