BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form BE-10) State of North Carolina Department of the Secretary of State STATEMENT OF CHANGE OF MAILING ADDRESS OF SURVIVING ENTITY* Pursuant to N.C.G.S. 247247 55-15-21(a)(4), 55A-11-09(d)(3) 55A-15-21(a)(4), 57D-7-21(a)(7) and 59-909(a)(4), as applicable, The undersigned business entity is giving notice that its mailing address has changed. 1. Name of the Business Entity: 2. Old Address: (mailing address previously filed with the Secretary of State) Number and Street: City: State: Zip Code: County: 3. New Address: Number and Street: City: State: Zip Code: County: 4. This Statement will be effective upon filing, unless a delayed date and/or time is specified: . This the day of , 20. Name of Entity Signature Type or Print Name and Title NOTES: 1. Filing fee is $10. This document must be filed with the Secretary of State. * This form should only be used by the surviving entity in a merger to notify the Secretary of State of a change in its mailing address after Articles of Merger or an Application for Certificate of Withdrawal by Reason of Merger, Consolidation or Conversion have been filed. This form should not be used to change the registered office address. A Statement of Change of Registered Office and/or Registered Agent should be used for that purpose. American LegalNet, Inc. www.FormsWorkFlow.com