NO FILING FEE REQUIRED CORPORATION (Not for LLCs) STATEMENT OF CHANGE OF KNOWN PLACE OF BUSINESS OR STATUTORY AGENT Pursuant to A.R.S. §§10-502, 10-1508, 10-11508 & 10-3502 NOTE: It is critical that the Corporation Commission receive information about the existing (old) official address and/or agent data as well as the new address or agent data. Please check with our Customer Call Center (602) 542-3026 or our web site, www.azcc.gov/divisions/corporations to obtain the correct information. 1. The exact name of the corporation on file with the Arizona Corporation Commission (ACC) is: ______________________________________________________________________________ 2. The ACC file number is: _________________________________ 3. The known place of business currently on file with the ACC is: ________________________________________ ________________________________________ ________________________________________ 4. The name and street address of the current statutory agent on file with the ACC is: _________________________________________ _________________________________________ _________________________________________ 5. (A) The known place of business in ARIZONA is to be changed. The street address of the new known place of business is: ________________________________________________________________ ________________________________________________________________ (B) Foreign corporations only: The known place of business in the State or Country in which the corporation was incorporated is to be changed. The new foreign address is: ________________________________________________________________ ________________________________________________________________ Indicate which address in which general correspondence can be mailed. 5(A)________ or 5(B)________. 6. (A) The address of the statutory agent is to be changed.* (If the statutory agent has a P.O. box or personal mail box (PMB) then he/she must also provide a physical location/address). ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ If only changing the statutory agent's address, the statutory agent is the only individual who must sign this statement. * By signing this document, the statutory agent acknowledges that he/she has given the corporation written notice of this change. AR: 0009 Rev: 06/2011 Arizona Corporation Commission Corporations Division Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Corporation Name: ________________________________ File Number:________________ (B) The statutory agent in ARIZONA is to be changed. The name and street address of the new statutory agent is: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ The new statutory agent must accept his/her appointment as the new statutory agent. Acceptance of Appointment By Statutory Agent** **(required only if a new statutory agent is being appointed) The undersigned hereby acknowledges and accepts the appointment as statutory agent of the above-named corporation effective this _____ day of _______________,_______ Signature:______________________________________________ Printed Name:_______________________Title: _______________ ______________________________________________________ If signing on behalf of a company, please print the company name here. Statutory agent must sign only if changing his/her address (Item 6(A)). Changes to corporation(s) other than changes to a statutory agent's address, must be executed by an officer of the corporation. Dated this ______ day of ____________, _________ Dated this ______ day of ____________, _________ Signature: __________________________________ Signature: __________________________________ Printed Name: _______________________________ Printed Name: _______________________________ __________________________________________ Title: _______________________________________ If signing on behalf of a company, please print the company name here. Deliver/Mail or Fax to: Arizona Corporation Commission Corporations Division - Corporate Filings Section 1300 W. Washington St., Phoenix, Arizona 85007-2929 602-542-4100 Fax Number: AR: 0009 Rev: 06/2011 Arizona Corporation Commission Corporations Division Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com