C-104G Rev. 7/1/02 New Jersey Division of Revenue CERTIFICATE of CHANGE of REGISTERED OFFICE &/or REGISTERED AGENT (For Use by Domestic and Foreign, Profit and Non-profit Corporations) CORPORATION NAME: STATE OF ORIGINAL INCORPORATION: IMPORTANT - INCLUDE INFORMATION ON BOTH THE PRIOR AND NEW AGENT PRIOR AGENT NAME: NEW AGENT NAME: PRIOR AGENT STREET ADDRESS NEW AGENT STREET ADDRESS CITY STATE ZIP CITY STATE NJ ZIP The corporation states that the address of its new registered office and the address of its new registered agent are identical. Further, the changes designated on this form were authorized by resolution duly adopted by its board of directors or members. By (Signature of Officer) Date: NOTE - This form must be executed by the chairman of the board, the president, or the vice president of the corporation. Title (Type) FEES: Change of Agent Name-$25.00 Change of Agent Address-$25.00 Change of Both-$25.00 MAIL TO: NJ Division of Revenue PO Box 308 Trenton, NJ 08646 Make checks payable to: TREASURER, STATE of NEW JERSEY (NO CASH PLEASE) American LegalNet, Inc. www.FormsWorkflow.com Rev 7/18/05 Instructions for Form C-104G CERTIFICATE of CHANGE of REGISTERED OFFICE and/or REGISTERED AGENT (Titles 14A, 15A and 42:2A) ***Form C-104G can be used for ALL corporations and limited partnerships*** STATUTORY FEE: $25.00 The MANDATORY fields are: Business Name List the name as it appears on the records of the Treasurer. Prior Agent Name List the current agent name as it appears on the records of the Treasurer. Prior Agent Office List the current agent office as it appears on the records of the Treasurer. New Agent Name If you are changing the registered agent, list the new name; otherwise, leave this field blank. New Office If you are changing the registered office, list the new address; otherwise, leave this field blank. Provide a New Jersey street address. A PO box may be used only if the street address is listed as well. ATTESTATIONS Add statements that indicate: 1) the address of its registered office and the address of its registered agent will be identical after the change is filed; and 2) the change is made pursuant to resolution of Board or membership. Form 104G provides these statements. EXECUTION (DATE/SIGNATURE) Have the chairman, president, vice-president, or current registered agent sign. Also, list the date of execution (signature). ********** These documents should be filed in duplicate. Non-profits should file in triplicate. Make checks payable to: TREASURER, STATE OF NEW JERSEY. (No cash, please) Mail to: NJ Division of Revenue, PO Box 308, Trenton, NJ 08646 American LegalNet, Inc. www.FormsWorkflow.com