Form 11 F0122 - Certificate Of Change Of Address Of Registered Agent

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11 F0122
OFFICE OF THE SECRETARY OF STATE
P O BOX 136, JACKSON, MS 39205-0136 601-359-1633
Certificate of Change of Address of Registered Agent
Name of Registered Agent
1. Name of Company represented by the Registered Agent
2. The street address at which the Registered Agent has maintained an office for each
company.
City
State
Zip
3. The new street address the Registered Agent will maintain for each company.
City
State
Zip
By: Signature of Registered Agent
Printed name
Mail completed form with the fee of $10 to SECRETARY OF STATE, PO BOX 136, JACKSON,
MS 39205-0136. For assistance contact a customer service representative at (800) 256-3494. Visit
our website at
for forms and instructions.

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