Mail all forms and required payments to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442 - 44 32 Corporate Online Services Information: Many corporate filings are available by using CorpOnline Service. Go to CorpOnline site at https://corp online .dcra.dc.gov , create the profile, access the online services main page and proceed. Online filers must pay by using the credit card. District of Columbia Government Corporations Division Statement of Change of Non c ommercial Registered Agent Form RA - 4 Ver. 3 , April 2018 . This form is for a noncommercial registered agent to change its name or its address and have this change reflected with respect to a represented entity . A statement of change takes effect on delivery of this statement for filing. A noncommercial registered agent promptly shall furnish the represented entity with notice in a record of the delivery of this statement for filing and the changes made in the statement. ENTITY TYPE FILING F E E Noncommercial Registered Agent Refer to Corporate Fee Schedule posted online. Under the provisions of the Title 29 of D.C. Code (Business Organizations Act), the following noncommercial registered agent is in the process of updating its name and address for a represented entity and for that purpose submits the statement below. 1.Domestic or Foreign Filing Entity Name. 2.Name of the Current Noncommercial Registered Agent. 2A. Current Noncommercial Registered Agent Address in DC. 3.New Name of Noncommercial Registered Agent. 3A. New Address of Noncommercial Registered Agent. If you sign this form you agree that anyone who makes a false statement can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC 247 22 - 2405; 4.Name of the Governor or Authorized Person. 4A . Signature of the Governor or Authorized Person. American LegalNet, Inc. www.FormsWorkFlow.com