Free 26276.PDF - Indiana

NOTICE OF CHANGE OF REGISTERED OFFICE OR REGISTERED AGENT (ALL ENTITIES)
Sta te Form 2 6276 (R7 / 1-03 )

TODD ROKITA SE CRETARY OF STATE CORPORATIO NS DIVIS ION 302 W. Washing ton St., Rm. E018 Indian apolis, IN 462 04 Teleph one: (317 ) 2 32-657 6 India na Co de 23-1-2 4-2 (fo r p rofit co rporation) India na Co de 23-17- 6-2 (non-p rofi t co rporation)

INSTRUCTIONS:

Use 8 1/2" x 11" white paper for attachments. Present original and one (1) copy to address in upper right corner of this form. Please TYPE or PRINT. Please visit our office on the web at www.sos.in.gov.

NO FILING FEE

Na me of entity

Date of incorpo ration / orga niza tio n / a dmission

Cu rrent re gistere d o ffice ad dress (numbe r a nd street, city, state, ZIP cod e)

Ne w regi stered office addr ess (number and street, ci ty, state , ZIP cod e)

Curre nt reg istered ag ent (typ e o r pr int name)

New registe red agen t (type or prin t name)

STATEMENTS BY REGISTERED AGENT OR ENTITY

This statement is a representation that the new registered agent has consented to the appointment as registered agent, or statement attached signed by registered agent giving consent to act as the new registered agent.

After the change or changes are made, the street address of this corporation's registered agent and the address of its registered office will be identical.

The registered agent filing this statement of change of the registered agent's business street address has notified the represented corporation in writing of the change, and the notification was manually signed or signed in facsimile.

IN WITNESS WHEREOF, the undersigned executes this notice and verifies, subject to the penalties of perjury, that the statements contained herein are true, this ________________ day of ____________________________ , 20 _____ .

Sign atu re

Title