FOR OFFICE USE ONLY COMMERCIAL OR NONCOMMERCIAL REGISTERED AGENT/OFFICE STATEMENT OF CHANGE ID Number SECRETARY OF STATE Filed WO Number By SFN 13019 (08-09) 1. FILING FEE: $10.00 NO FEE: To change the address resulting from a postal reassignment, rezoning, or 911 address implementation TYPE OR PRINT LEGIBLY SEE REVERSE SIDE FOR FEES, FILING AND MAILING INSTRUCTIONS For reference, see North Dakota Century Code, Chapter 10-01.1. 2. Name of the organization (cooperative association, corporation, limited liability company, limited liability partnership, limited partnership, limited liability limited partnership, or real estate investment trust) 4.A. Name of commercial registered agent in North Dakota OR 4.B. 3. Federal ID Number Name of noncommercial registered agent in North Dakota (or new name of current noncommercial registered agent) 5A. New address of the noncommercial registered agent named in number 4B (It cannot only be a post office box; it must include the noncommercial registered agent's physical address in North Dakota.) If applicable for mailing purposes, a post office box can be added to the physical address. Physical Address City PO Box State Zip B. Change of address is: (check one) Appointment of a new commercial or noncommercial registered agent. New location for current noncommercial registered agent Postal reassignment, rezoning, or implementation of 911 address. C. Is the address in number 5a the same address as the principal place of business for the organization named in number 2? Yes No 6. If a new commercial registered agent or a new noncommercial registered agent has been named in number 4A or 4B, an officer, manager, or other individual authorized by the organization named in number 2 may sign the following certification. If only the address of the current noncommercial registered agent is changing or the noncommercial registered agent has changed their name, then the noncommercial registered agent may sign the certification. "As required by state law, I certify that: The new commercial registered agent or new noncommercial registered agent named in number 4A or 4B, if applicable, was appointed by a resolution as required by state law , and was adopted by the governing structure of the organization named in number 2; The new address in number 5A, if applicable, for the current or newly appointed noncommercial registered agent is the same address where the noncommercial registered agent can be located during normal business hours; The undersigned has read the foregoing statements, knows the contents thereof and believes same to be true; The undersigned is authorized to sign the statement; and The Secretary of State is authorized to correct numbers 2, 4A, and 4B if not correctly reflected." Signature 7. Name of person to contact about this document Date E-Mail Address: Daytime Phone Number (with extension if applicable) American LegalNet, Inc. www.FormsWorkFlow.com SFN 13019 (08-09) Page 2 INSTRUCTIONS FOR COMMERCIAL OR NONCOMMERCIAL REGISTERED AGENT/OFFICE STATEMENT OF CHANGE The following organizations must continuously maintain a commercial or noncommercial registered agent on file with the Secretary of State: e) Domestic and foreign limited partnerships a) Domestic and foreign business, cooperative, nonprofit & f) Domestic and foreign limited liability limited partnerships professional corporations g) Domestic and foreign limited liability partnerships b) Domestic farm corporations h) Real estate investment trusts c) Domestic farm limited liability companies d) Domestic and foreign limited liability companies The Registered Agent/Office Statement of Change must be promptly filed upon the event of any of the following: a) Organization changes its commercial or noncommercial registered agent, e) Noncommercial registered agent has changed address, or b) Commercial or noncommercial registered agent resigns, f) Address of a noncommercial registered agent has been changed as a c) Noncommercial registered agent changes its name, result of rezoning or postal reassignment. d) Commercial or noncommercial registered agent relocates outside of North Dakota, The Commercial or Noncommercial Registered Agent/Office Statement of Change need not be filed to report an addition or change of a post office box number. That change can be reported to the Secretary of State with any filing of the organization or by contacting the Secretary of State by phone or in writing to the address at the bottom of page 3. A commercial registered agent must be registered as a commercial registered agent with the North Dakota Secretary of State. The appointed agent can verify their status as a commercial registered agent from their acknowledged filing and from the list of commercial registered agents maintained on the Secretary of State's website at www.nd.gov/sos. A noncommercial registered agent may be one of the following: a) An individual residing in North Dakota, b) A domestic or foreign corporation, or c) A domestic or foreign limited liability company. A corporation or limited liability company, appointed as a noncommercial registered agent must be registered with the Secretary of State, be in good standing, and have a business address in North Dakota. If a corporation or limited liability company is named as a noncommercial registered agent, provide the "correct" name of the organization. Seek the approval of the party before naming them as the commercial or noncommercial registered agent. Proof of the approval is not required to be filed with the Secretary of State. The following numbers correspond to the numbered sections on the front of this form. 1. FILING FEE: $10 (Checks must be payable to "Secretary of State" and must be for U.S. negotiable funds. Payment may also be made by credit card using VISA, Master Card, or Discover.) NO FEE: A fee is not required to add or change a post office box number or when an address change is the result of rezoning or postal reassignment. This includes address changes for implementation of 911 Emergency Service addresses. 2. Provide the exact name of the corporation, limited liability company, limited liability partnership, limited partnership, limited liability limited partnership, or real estate investment trust for which the Commercial or Noncommercial Registered Agent/Office Statement of Change is intended. This name must be exactly as currently registered with the North Dakota Secretary of State. If the name in number 2 is not the same as currently reflected on the organization record on file with the Secretary of State, the name will be corrected by the Secretary of State when the document is received. 3. To properly maintain organization records, the Federal ID number is requested. Privacy: In compliance with North Dakota laws, social security or Federal ID numbers are not disclosed to the public. They are used by the Secretary of State to maintain accurate entity files. Therefore, while voluntary disclosure is requested, failure to do so will not result in rejection of the document. 4. Only complete number 4A or 4B if you are changing your current commercial or noncommercial registered agent. 4A. If a commercial registered agent is being appointed, provide the correct name as registered with the North Dakota Secretary of State. If the name in number 4A is not the same as registered by the commercial registered agent, the name will be corrected by the Secretary of State when the document is received. OR 4B. If a noncommercial registered agent is being appointed, provide the correct name. If another corporation or limited liability company is appointed as registered agent and the name of that organization in number 4B is not the same as registered, the name will be corrected by the Secretary of State when the document is received. 5A. Only complete this section if you are making a change to the noncommercial registered agent's address or have a newly appointed noncommercial registered agent. The address must include the noncommercial registered agent's physical address (street or rural address), a post office box if applicable, the city and the state, and a zip code with its 4 digit extension. The physical address cannot be only a post office box. Even if a noncommercial registered agent uses a post office box for mailing purposes, the law still requires the physical address for service of process purposes. 5B. Indicate whether the Statement of Change is a result of: (leave blank if 5A is blank) Appointment of a new commercial or noncommercial registered agent; New location for the current noncommercial registered agent; or Postal reassignment, rezoning, or implementation of 911 address. 5C. Indicate whether the address in number 5A is also the address of the principal place of business of the organization named in number 2. (leave blank if 5A is blank) 6. The Commercial or Noncommercial Registered Agent/Office Statement of Change must be signed and dated. If number 4A or 4B is completed appointing a new commercial or noncommercial registered agent, the organization named in number 2 must authorize the appointment by resolution and an officer, a manager, a partner, or an individual authorized by the organization must sign the Commercial or Noncommercial Registered Agent/Office Statement of Change. If the current noncommercial registered agent of record is changing its name or its address as indicated in number 5A, the noncommercial registered agent may sign the Commercial or Noncommercial Registered Agent/Office Statement of Change. American LegalNet, Inc. www.FormsWorkFlow.com SFN 13019 (08-09) Page 3 INSTRUCTIONS FOR COMMERCIAL OR NONCOMMERCIAL REGISTERED AGENT/OFFICE STATEMENT OF CHANGE 7. List the name, e-mail address, and daytime telephone number in case this office has any questions or needs additional information to file this document. ASSISTANCE: If assistance is required to complete this document, contact the Secretary of State. FAX FILING: The document and Credit Card Payment Authorization may be faxed to 701-328-2992. A faxed filing does not expedite the process of the document in the office of the Secretary of State. When faxing to the Secretary of State, maintain the fax transmission log as proof that the document was timely filed. EMAIL: Email is not a secure utility for the transmission of private information or credit card authorizations. DO NOT EMAIL YOUR DOCUMENT TO THE SECRETARY OF STATE. MAILING INSTRUCTIONS: Send the completed document to: Secretary of State State of North Dakota 600 E Boulevard Avenue, Dept. 108 PO Box 5513 Bismarck ND 58506-5513 Telephone: 701-328-4284 Toll Free: 800-352-0867 (8-4284) Fax: 701-328-2992 Home Page:www.nd.gov/sos CREDIT CARD PAYMENT AUTHORIZATION SECRETARY OF STATE SFN 51478 (07-09) (All items required to complete transaction) Name Amount Authorized Address VISA Account Number City Master Card State Zip Code Signature (Required by credit card companies) Discover V Number Card Expires Month Year - Date American LegalNet, Inc. www.FormsWorkFlow.com