Reset Form Prescribed by: The Ohio Secretary of State Central Ohio: (614) 466-3910 Toll Free: 1-877-SOS-FILE (1-877-767-3453) www.sos.state.oh.us e-mail: busserv@sos.state.oh.us Mail Form to: Ohio Secretary of State 180 E. Broad St, 16th Floor Attn: Multiple Agent Change Columbus, OH 43215 MULTIPLE AGENT NAME AND ADDRESS CHANGE (For Domestic or Foreign, Profit or Nonprofit) (1) Request to standardize address for Statutory Agent on record. (2) Change Agent name or address for entities listing the agent indicated below as current Statutory Agent. Filing Fee $125.00 Filing Fee $125.00 plus $3.00/change Complete the information in this section for the box checked above Current Agent Name: Current Agent Address: Ohio (City) (State) (Zip Code) Complete the information in this section if Box (1) is checked I hereby request the Secretary of State to standardize the name and address for the Statutory Agent indicated above as shown. I acknowledge that entities containing an agent address that are not a variation of the above address will not be changed. I also hereby request that the Secretary of State use the above address for future filings that name the above corporation or person as agent. I agree to use the assigned number issued by the Secretary of State to assist in the standardization process. Please note: Only active entities can have their agent information updated. (Authorized Signature) (Print Name) (Date) 526 Page 1 of 2 Last Revision Nov. 2002 American LegalNet, Inc. www.FormsWorkflow.com Complete the information in this section if Box (2) is checked Please note that the Name of Agent can only be changed if: The person who is agent has legally changed their name; if the Agent is a corporation whose name has changed through an amendment or a merger, in which they are the survivor and on record with the Secretary of State's office. Only active entities can have their agent information changed. New Agent Name (If Applicable) New Agent Address: Ohio (City) (State) (Zip Code) I wish to have the Secretary of State produce a listing of all entities for which the name and address given under Current information above is listed as the Statutory Agent. I wish to have the Secretary of State produce a listing of all entities for the agent named above, regardless of the agent address currently listed. I hereby agree to pay the $125.00 fee for the listing the Secretary of State will produce as indicated above. I will then review the list, indicate which entities to have the Agent Address information changed and which entities not to change. I will return said listing with a filing fee equal to $3.00 for every entity address to be changed. I agree to use the assigned number issued by the Secretary of State to assist in the standardization process. (Authorized Signature) (Print Name) (Date) 526 Page 2 of 2 Last Revision Nov. 2002 American LegalNet, Inc. www.FormsWorkflow.com Instructions for Multiple Agent Name and Address Change Every agent, referred to as the "statutory agent", for business entities recorded with the office of the secretary of state, upon changing their corporate or individual name or agent address, shall forthwith file with this office, on the form prescribed by the secretary of state, a written statement setting forth the new name and/or address. The Multiple Agent Name and Address Change form is for those persons or corporations serving as statutory agent for multiple entities on record with the secretary of state. This form is not to be used to appoint a new statutory agent, only to modify the information for the existing statutory agent. Current Agent Name and Address Information The name and address of the statutory agent as it is currently listed or should be listed in the records of the secretary of state should be entered in the space provided. This information is used to locate the records of entities listing the named person or corporation as agent. If box (1) is checked, this is the name and address to which all variations of that agent name and address will be changed. Follow these instructions if box (1) is checked The agent's signature, printed name and date of signing must be on the form to request the secretary of state to standardize how the agent's name and address are recorded. If the statutory agent is a corporation, then either a corporate officer or an authorized individual may sign on behalf of the corporation. The filing fee of $125.00 must be paid when the form is submitted. Follow these instructions if box (2) is checked The new agent name, if applicable, and address must be filled in and the appropriate box checked. The agent's signature, printed name and date of signing must be on the form to request the secretary of state to standardize how the agent's name and address are recorded. If the statutory agent is a corporation, then either a corporate officer or an authorized individual may sign on behalf of the corporation. The filing fee must be paid in the following manner: The fee of $125.00 must accompany the form for the initial listing to be produced. Upon reviewing the multiple agent name and address list, please indicate which entities should have the name and/or address changed. The list should be signed, returned and include a $3.00 fee per agent name and/or address change. American LegalNet, Inc. www.FormsWorkflow.com