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STATEMENT OF CHANGE OF REGISTERED OFFICE

OR REGISTERED AGENT, OR BOTH

File #: _______________

The undersigned entity submits the following statement for the purpose of changing its registered office or

its registered agent, or both, in the State of Idaho.

1. The name of the entity is: ___________________________________________________________________

_______________________________________________________________________________________

2. The street address of its present registered office is: _____________________________________________

_______________________________________________________________________________________

3. The street address (not a P.O. box) to which its registered office is to be changed is: ____________________

_______________________________________________________________________________________

4. The name of its old registered agent is: ________________________________________________________

5. The name of its new registered agent is: _______________________________________________________

6. The address of the registered office and the business address of the registered agent are identical.

Dated: ________________________________

Signed:_____________________________________________

Printed:_____________________________________________

Capacity:_____________________________________________

I consent to serve as registered agent

(See reverse for instructions)

for the above-named entity.

(Signature of new registered agent)

FILE ONE COPY

NO FEE REQUIRED

g:\corp\forms\miscforms\changeRA_RO.p65

STATEMENT OF CHANGE OF REGISTERED OFFICE

OR REGISTERED AGENT, OR BOTH

File #: _______________

The undersigned entity submits the following statement for the purpose of changing its registered office or

its registered agent, or both, in the State of Idaho.

1. The name of the entity is: ___________________________________________________________________

_______________________________________________________________________________________

2. The street address of its present registered office is: ______________________________________________

_______________________________________________________________________________________

3. The street address (not a P.O. box) to which its registered office is to be changed is: ____________________

_______________________________________________________________________________________

4. The name of its old registered agent is: ________________________________________________________

5. The name of its new registered agent is: _______________________________________________________

6. The address of the registered office and the business address of the registered agent are identical.

Dated: ________________________________

Signed:_____________________________________________

Printed:_____________________________________________

Capacity:_____________________________________________

I consent to serve as registered agent

for the above-named entity.

(See reverse for instructions)

(Signature of new registered agent)

FILE ONE COPY

NO FEE REQUIRED

g:\corp\forms\miscforms\changeRA_RO.p65

Statement Of Change Of Registered Office Or Registered Agent, Or Both - Idaho Secretary Of State

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