Registration Information Change Form - 2002

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State of Utah
This form must be type written or
Non-Refundable Processing Fee $12.00
computer generated. For your
DEPARTMENT OF COMMERCE
convenience, this form has been
Print Form
Division of Corporations & Commercial Code
designed to be filled out and
printed online.
Clear Form
Registration Information Change Form
Please make appropriate corrections or changes to registered information on this form. Means of payment are: cash, check, or money order
made payable to the “State of Utah.” If you are faxing you must include, on a cover sheet, the number of a Visa or MasterCard with the date
of expiration.
Note: If you are using this form with a reinstatement or renewal please do not include the $12.00 processing fee with the reinstatement
or renewal fee.
WHEN REPLACING THE REGISTERED AGENT THE NEW AGENT MUST SIGN.
DO NOT USE THIS FORM if you are resigning as an Officer, Director or Registered Agent. You must submit a Letter of Resignation. There is no fee
associated with a Letter of Resignation. You must file an amendment to the Articles of Organization to add a manager or member to an LLC filing.
ENTITY FILE #
____________________________
REGISTRATION DATE _____________________________
1.
REGISTERED NAME
__________________________________________________________________________________________________________
New Registered Agent must sign here after the form is
(Required Information)
printed
2.
REGISTERED AGENT
___________________________________________________________________/_______________________________________
First
Middle
Last
NEW AGENT MUST SIGN ABOVE
3.
REGISTERED ADDRESS
__________________________________________________________________________________________________________
Street Address Required
4.
CITY, STATE & ZIP
_________________________________________________________________________________UTAH____________________
Registered Agent Must Be In Utah
5.
PURPOSE OF BUSINESS
__________________________________________________________________________________________________________
6.
ADDRESS OF:
[ ] PRINCIPAL OFFICE
_______________________________________________________________
[ ] DESIGNATED OFFICE (LLC – DOMESTIC)
Street Address
_______________________________________________________________
City
State
Zip
POSITION TO CHANGE
NAME
ADDRESS
7. [ ] Add __________________________ ________________________________
ADDRESS____________________________________________________________________________________
[ ] Remove
________________________________
CITY____________________________________________________STATE___________ZIP_________________
Signature (if required)
8. [ ] Add __________________________
________________________________
ADDRESS____________________________________________________________________________________
[ ] Remove
________________________________
CITY____________________________________________________STATE___________ZIP_________________
Signature (if required)
9. [ ] Add __________________________
________________________________
ADDRESS____________________________________________________________________________________
[ ] Remove
________________________________
CITY____________________________________________________STATE___________ZIP_________________
Signature (if required)
10. [ ] Add _________________________
________________________________
ADDRESS____________________________________________________________________________________
[ ] Remove
________________________________
CITY____________________________________________________STATE___________ZIP_________________
Signature (if required)
11. [ ] Add _________________________
________________________________
ADDRESS____________________________________________________________________________________
[ ] Remove
________________________________
CITY____________________________________________________STATE___________ZIP_________________
Signature (if required)
12. [ ] Add _________________________
________________________________
ADDRESS____________________________________________________________________________________
[ ] Remove
________________________________
CITY____________________________________________________STATE___________ZIP_________________
Signature (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.
Authorized party must sign here after the form is printed
BY_____________________________________________ Title_______________________________________ Date___________________
Signature of Authorizing Party
Mail In: PO Box 146705
Salt Lake City, UT 84114-6705
Walk In:160 East 300 South, Main Floor
Information Center: (801) 530-4849
Toll Free: (877) 526-3994 (within Utah)
Fax: (801) 530-6438
Web Site:
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 09/02

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