Statement Of Change Of Designated Office, Registered Agent And/or Registered Agent'S Address

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STATEMENT OF CHANGE OF DESIGNATED OFFICE,
REGISTERED AGENT
and/or REGISTERED AGENT’S ADDRESS
LIMITED LIABILITY COMPANY
Submit in Duplicate
John A. Gale, Secretary of State
Room 1301 State Capitol, P.O. Box 94608
Lincoln, NE 68509
(402) 471-4079
Name of Limited Liability Company _______________________________________________________
_____________________________________________________________________________________
Complete all current information and check the item or items that are being changed and provide
the appropriate information:
Current:
Designated Office/
Principal Office
_________________________________________________________________
Street and Mailing Address
City
State
Zip
Registered Agent:
_________________________________________________________________
Agent’s Address:
____________________________________________________NE__________
Street Address and Post Office Box Number (if any)
City
Zip
New:
Designated Office/
Principal Office:
_________________________________________________________________
Street and Mailing Address
City
State
Zip
Registered Agent:
_________________________________________________________________
Agent’s Address:
____________________________________________________NE__________
Street Address and Post Office Box Number (if any)
City
Zip
Effective date if other than the filed _____________________________.
_______________________________________
Signature of Authorized Representative
_______________________________________
Printed Name of Authorized Representative
FILING FEE: $15.00
3/20/2012
Neb. Rev. Stat.
21-114
§

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