Statement Of Change Of Registered Office And/or Registered Agent Form - 2011 Page 2

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INSTRUCTIONS FOR
STATEMENT OF CHANGE OF REGISTERED OFFICE AND/OR REGISTERED AGENT
Limited Liability Companies must submit a Statement of Change form to change the Registered Office and/or Registered Agent
in Iowa.
It is important to read these INSTRUCTIONS before you fill out the Change form. The numbers on these instructions
correspond to the numbering on the form. PLEASE PRINT LEGIBLY.
1.
Print the full name of the Limited Liability Company on line 1.
2. & 3.
Print the street and mailing address, city, state and zip code of the CURRENT and the NEW Registered Office.
4. & 5.
Print the full name of the CURRENT and the NEW Registered Agent.
6.
Line 6 of the Statement of Change form should be signed by a person authorized by the company. It must also state the
date signed, the person’s name, and the capacity in which the person signed.
NOTES:
1. There is NO FILING FEE.
2. One copy is to be delivered or faxed to the Secretary of State for filing.
3. The information you provide will be open to public inspection under Iowa Code chapter 22.11
SECRETARY OF STATE
Business Services Division
Lucas Building, 1st Floor
Des Moines, Iowa 50319
Phone: (515) 281-5204
FAX: (515) 281-7142 or (515) 242-5953
Website:
635_08_1
rev. 01/11

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