Statement Of Change By Commercial Registered Agent
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1ROSS MILLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684 5708
Website:
Statement of Change by
Commercial Registered Agent
(PURSUANT TO NRS 77.360)
This form may be submitted by: an agent that has filed a Commercial
Registered Agent Listing Statement with this office to amend the
information in the original statement. For more information please visit
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
1. Name of Commercial Registered Agent as currently listed in Nevada:
2. Information being changed:
(check all that apply)
Name of Commercial Registered Agent
Email
Type
Jurisdiction
Address
3. Commercial Registered Agent Information in effect upon filing of this statement:
Name of Individual:
or
Name of Entity:
Entity Type:
Jurisdiction of Organization:
Nevada
Street Address
City
Zip Code
Nevada
Mailing Address (if different from street address)
City
Zip Code
Email address where electronic notices may be sent:
4. Signature of Commercial Registered Agent:
X
Date
Authorized Signature of Registered Agent or On Behalf of Registered Agent Entity
FEE: $60.00
Nevada Secretary of State Form Change by CRA
This form must be accompanied by appropriate fees.
Effective 12-8-08
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