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Statement Of Change Changing Information Other Than Principal Office Address Or Registered Agent Information Form. This is a Colorado form and can be use in Corporation Secretary Of State.
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Tags: Statement Of Change Changing Information Other Than Principal Office Address Or Registered Agent Information, Colorado Secretary Of State, Corporation
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If document is filed on paper
$10.00
If document is filed electronically
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Fees & forms/cover sheets
are subject to change.
To file electronically, access instructions
for this form/cover sheet and other
information or print copies of filed
documents, visit www.sos.state.co.us
and select Business.
Paper documents must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
Statement of Change Changing Information Other Than Principal Office Address
or Registered Agent Information
filed pursuant to §7-90-305.5 and, if applicable, §7-90-804 of the Colorado Revised Statutes (C.R.S.)
ID number:
_____________________
1. Entity name:
______________________________________________________
2. True name:
(if different from the entity name)
______________________________________________________
Complete lines 3 - 9 as applicable. You must complete section 10.
3. Document number:
_____________________
(required for change(s) to 4, 5, 6, 7
and/or 8 below)
4. Change of entity name of record (LLP, art. 61 LLLP or foreign entity only):
New entity name:
_____________________________________________________
5. Change of true name of record (LLP, art. 61 LLLP, general partnership or foreign entity only):
New true name:
______________________________________________________
6. Change of jurisdiction of formation of record (foreign entity only):
New jurisdiction of formation:
______________________________________________________
7. Change of entity form of record (foreign entity only):
New entity form:
CHANGE_OTHER
______________________________________________________
Page 1 of 2
Rev. 12/01/2009
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8. Other change(s) not provided for above:
If other information contained in the filed document is being changed, mark this box
include an attachment stating the information to be changed and each such change.
If other information is being added or deleted, mark this box
stating each addition or deletion.
9. (Optional) Delayed effective date:
and
and include an attachment
______________________
(mm/dd/yyyy)
Notice:
Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is
such individual's act and deed, or that such individual in good faith believes such document is the act and deed
of the person on whose behalf such individual is causing such document to be delivered for filing, taken in
conformity with the requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent
documents and the organic statutes, and that such individual in good faith believes the facts stated in such
document are true and such document complies with the requirements of that Part, the constituent documents,
and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the Secretary of
State, whether or not such individual is identified in this document as one who has caused it to be delivered.
10. The true name and mailing address of the individual causing this document to be delivered for filing are
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ _____
(City)
(State)
____________________
(ZIP/Postal Code)
_______________________ ______________________________
(Province – if applicable)
(Country)
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains the true name and mailing address of one or more additional individuals
causing the document to be delivered for filing.
Disclaimer:
This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice,
and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy
minimum legal requirements as of its revision date, compliance with applicable law, as the same may be
amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should
be addressed to the user’s legal, business or tax advisor(s).
CHANGE_OTHER
Page 2 of 2
Rev. 12/01/2009
American LegalNet, Inc.
www.FormsWorkFlow.com
Mail form to:
Colorado Secretary of State
1700 Broadway Ste 200
Denver, CO 80290
Make checks payable to: Colorado Secretary of State
Do not include this page with your filing.
American LegalNet, Inc.
www.FormsWorkFlow.com
