Form Ra-Ro - Statement Of Change By Business Entity - Wyoming Secretary Of State
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1Wyoming Secretary of State
State Capitol Building, Room 110
th
200 West 24
Street
For Office Use Only
Cheyenne, WY 82002-0020
Ph. (307) 777-7311
Fax (307) 777-5339
Email: Business@wyo.gov
Statement of Change By Business Entity
1. Name of the business entity:
2. Name of current registered agent and physical address of current registered office:
Current Registered Agent:
Current Registered Office:
3. Name of new registered agent and physical Wyoming address of new registered office (cannot be a PO Box):
New Registered Agent:
For consistency the Secretary of State’s Office will only keep one version of the agent’s name on file.
New Registered Office:
Registered Agent Mailing
Address (if different than above):
4. I hereby certify that the new registered office and the registered agent comply with the requirements of W.S. 17-28-101
through W.S. 17-28-111.
5. The mailing address of my business should be changed to reflect the new registered office address.
Yes
No
6. The principal address of my business should be changed to reflect the new registered office address. Yes
No
7. After the changes are made, the physical address of the registered office and business office of the registered agent will be
identical.
Signature: ______________________________________________
Date:
(Shall be executed by an authorized individual)
(mm/dd/yyyy)
Print Name:
Contact Person:
Title:
Daytime Phone:
Email:
Checklist
Filing Fee: Nonprofit Corporation - $3.00 (by statute); All other business entities - No Fee
The Statement must be accompanied by a written consent to appointment executed by the registered agent.
Please submit one originally signed document and one exact photocopy of the filing.
Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in
the processing of your documents.
RA-RO ChangeByEntity – 05/2012
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