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Form Bca 5.10/5.20 - Statement Of Change Of Registered Agent And/or Registered Office Page 2

(If authorized by the board of directors, sign here. See Note 5)

The undersigned corporation has caused this statement to be signed by a duly authorized officer who affirms,

under penalties of perjury, that the facts stated herein are true.

Dated ____________________________ ,

_____

_____________________________________________

(Month & Day)

(Year)

(Exact Name of Corporation)

________________________________________

(Any Authorized Officer’s Signature)

________________________________________

(Type or Print Name and Title)

(If change of registered office by registered agent, sign here. See Note 6)

The undersigned, under penalties of perjury, affirms that the facts stated herein are true.

Dated ____________________________ ,

_____

_____________________________________________

(Month & Day)

(Year)

(Signature of Registered Agent of Record)

_____________________________________________

(Type or print name. If the registered agent is a corporation, type

or print the name and title of the officer who is signing on its

behalf.)

NOTES

The registered office may, but need not be the same as the principal office of the corporation. However, the

registered office and the office address of the registered agent must be the same.

The registered office must include a street or road address; a post office box number alone is not acceptable.

A corporation cannot act as its own registered agent.

If the registered office is changed from one county to another, then the corporation must file with the recorder

of deeds of the new county a certified copy of the articles of incorporation and a certified copy of the statement

of change of registered office. Such certified copies may be obtained ONLY from the Secretary of State.

Any change of registered agent must be by resolution adopted by the board of directors. This statement must

then be signed by a duly authorized officer.

The registered agent may report a change of the registered office of the corporation for which he or she is

registered agent. When the agent reports such a change, this statement must be signed by the registered

agent. If a corporation is acting as the registered agent, a duly authorized officer of such corporation must sign

this statement.

Form Bca 5.10/5.20 - Statement Of Change Of Registered Agent And/or Registered Office Page 2