C-104D Rev. 3/96 New Jersey Division of Revenue NOTIFICATION OF CHANGE OF ADDRESS OF REGISTERED OFFICE (For Use by Domestic and Foreign, Profit and Nonprofit Corporations) CHECK THE APPROPRIATE STATUTE: ____ TITLE 14A:4-3 New Jersey Business Corporation Act ____ TITLE 15A:4-3 New Jersey Nonprofit Corporation Act In accordance with the provisions of the appropriate Statute, checked above, the Department of the Treasury is hereby notified that the address of the following _______ named corporations has been changed as indicated. (number) FROM: (Street and Postal Designation, if applicable) (City) (State) (Zip) TO: (Street and Postal Designation, if applicable) (City) (State) (Zip) LIST NAMES OF CORPORATIONS ALPHABETICALLY The address of the Registered Office of each of the above named corporations will be identical after the change and twenty (20) days notice, in writing, has been given to each of the corporations. The change of address of the Registered Office of each of the corporations named herein shall become effective upon the date of filing of this Certificate in the Office of the Treasurer or at such later time, not to exceed 30 days after the date of filing, as may be set forth herein. Effective date (if other than date of filing) will be . Signature: Agent's Name: Date: NJ Division of Revenue, PO Box 308, Trenton, NJ 08646 American LegalNet, Inc. www.FormsWorkflow.com (Rev 7/18/05) Instructions for Form C-104D NOTIFICATION of CHANGE of ADDRESS of REGISTERED AGENT OFFICE FOR ALL CORPORATIONS (Titles 14A and 15A) STATUTORY FEE: $25.00 for each corporation listed on form The MANDATORY fields are: Prior Office List the current office as it appears on the records of the Treasurer. New Office List the new address. Provide a New Jersey street address. A PO box may be used only if the street address is listed as well. Affected Corporations List each corporation affected by the change; show the name(s) as it appears on the records of the Treasurer. ATTESTATIONS Add statements indicating: 1) an understanding that the resignation is effective upon the filing of the change form with the Treasurer, or at a later time not to exceed 30 days from the date of filing; 2) that the address of the registered office of each corporation and the address of its registered agent will be identical after the change is filed; and 3) that at least 20 days prior notice of the change has been given to each corporation in writing. Form 104D provides the requisite statements. EXECUTION Have the 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