STATEMENT OF CHANGE OF REGISTERED
Secretary of State Office
500 E Capitol Ave
FILE DATE
____________________
OFFICE OR REGISTERED AGENT OR BOTH
Pierre, SD 57501
RECEIPT NO ___________________
(605)773-4845
Please Type or Print Clearly in Ink
Original
Photocopy
Please submit one
and one
Clear Form
FILING FEE: $10
SECRETARY OF STATE
Make check payable to
1. Corporate ID and Name:
HELP
Search for Corporate ID, Name and Agent
Telephone # ____________________
FAX #
_______________________
2. The name of the registered agent on file ______________________________________________________________
The name of the successor registered agent __________________________________________________________
3. If listing a Commercial Registered Agent, please state their identification number _____________________________
4. The address of the agent currently on file for this entity
______________________________________________________________________________________________
Street Address (Required)
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional)
City
State
ZIP+4
5. If the address has changed, its new address
______________________________________________________________________________________________
Street Address (Required to be a South Dakota Address)
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional – Required to be a South Dakota Address)
City
State
ZIP+4
6. The address of its registered office and the address of the business office of its registered agent, as changed, must be
identical.
The undersigned entity submits the following statement for purpose of changing its registered office and/or its registered
agent in the State of South Dakota.
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Statementofchangeentity July2008