Domestic Change Of Registered Agent Or Office - Non-Profit Corporations - Nebraska Secretary Of State

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DOMESTIC CHANGE OF
REGISTERED AGENT and/or OFFICE
NON-PROFIT CORPORATIONS
Submit in Duplicate
John A. Gale
, Secretary of State
Room 1301 State Capitol, P.O. Box 94608
Lincoln, NE 68509
The following corporation, pursuant to the laws of the state of Nebraska, does hereby
wish to change its Registered Agent and/or Registered Office.
Name of Corporation__________________________________________________________
Previous:
Registered Agent:
__________________________________________________________
Registered Office:
________________________________________NE________________
Street Address and Post Office Box (if any)
City
Zip
New:
Registered Agent:
___________________________________________________________
Registered Office*: _________________________________________NE_______________
Street Address and Post Office Box (if any)
City
Zip
* The street address of the registered office and the street address of the registered agent must be
identical.
DATED___________________________
___________________________________
Signature
___________________________________
Printed Name/Title
NOTE: Every filing must be signed by the presiding officer of the board of directors, the president, or one of the officers
of the corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing shall
be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed
fiduciary, the filing shall be signed by that fiduciary. Signing a false document which is filed or attempted to be
filed with the Secretary of State is a Class I Misdemeanor, subject to up to one year imprisonment or a $1000
fine, or both.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____
Registered Agent: Please check A (current agent) or B (new agent) below and sign
____ A. I hereby state that the above named corporation has been notified of the change in
address of my registered office.
____B. I hereby consent to act as registered agent for the above named corporation.
___________________________________
Signature of Registered Agent
__________________________________________________________________________________________________________________
FILING FEE: $10.00
Revised 07/18/2008
Neb. Rev. Stat. 21-1935

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