Free RETURN TO - South Dakota

Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845

COMMERCIAL REGISTERED AGENT CHANGE OF NAME OR ADDRESS
Please Type or Print Clearly in Ink

RECEIPT NO ___________________

Please submit one Original and one Photocopy

Clear Form
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FILING FEE: $10 per Entity Represented
Payable to SECRETARY OF STATE

The Commercial Registered Agent (CRA) identified below submits to the Secretary of State the following change of name or address. 1. The Commercial Registered Agent CRA# _____________________________________________________________ 2. The current CRA name ___________________________________________________________________________ The new CRA name _____________________________________________________________________________ 3. The current address on file ______________________________________________________________________________________________
Street Address City State ZIP+4

______________________________________________________________________________________________
Mailing Address (Optional) City State ZIP+4

The 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

4. The jurisdiction of organization _____________________________________________________________________ The new jurisdiction _____________________________________________________________________________ 5. The type of organization __________________________________________________________________________ New type of organization __________________________________________________________________________ The statement of change shall be signed by or on behalf of the commercial agent.

Dated ____________________________

______________________________________________
(Signature of an authorized officer)

______________________________________________
(Printed Name)

______________________________________________
(Title) Statementofchangecomm July2008