State of Utah DEPARTMENT OF COMMERCE Division of Corporations & Commercial Code Limited Liability Company Registration Information Change Form Non-Refundable Processing Fee: $12.00 Entity File Number: _________________________ Entity Name: ___________________________________________________________________________________________ For each Yes button that you mark the question will appear below for you to fill out. 1). Do you want to Change the Business Purpose? Yes No 1). If Yes, what is the new Business Purpose? _______________________________________________________________ 2). Do you want to Change the Registered Agent or the Address of the Registered Agent? Yes No 2). If Yes, who is the new Registered Agent, or the new Address of the Registered Agent? Name: ___________________________________________ Signature: __________________________________________ Address: ________________________________________________ City ___________________ State ______ Zip __________ (Utah Street Address Required, PO Boxes can be listed after the street address) 3). Do you want to Change the Principal Address of the Business Entity? Yes No 3). If Yes, what is the new Principal Address? Address: ________________________________________________ City ___________________ State ______ Zip __________ 4). Do you want to Change the Designated Office of the Business Entity? Yes No 4). If Yes, what is the new Designated Office? Address: ________________________________________________ City ___________________ State ______ Zip __________ 5). Do you want to Add individuals to the Business Entity? Yes No 5). If Yes, who do you want to Add to the Business Entity and what Position will they hold? Select/Type the position here Name: ____________________________________________ Position: ___________________________________________ Address: ________________________________________________ City ___________________ State ______ Zip __________ Name: ____________________________________________ Select/Type the position here Position: ___________________________________________ Address: ________________________________________________ City ___________________ State ______ Zip __________ 6). Do you want to Remove individuals from the Business Entity? Yes No 6). If Yes, who do you want to Remove from the Business Entity and what Position do they hold? Select/Type the position here Name: _________________________________________ Position: ___________________________________________ Name: _________________________________________ Select/Type the position here Position: ___________________________________________ 7). Do you want to Change the Address of the Business Entity’s Principal(s)? 7). If Yes, who is the Principal(s) whose Address you wish to Change? Name: ____________________________________________ Yes No Select/Type the position here Position: ___________________________________________ Address: ________________________________________________ City ___________________ State ______ Zip __________ Name: ____________________________________________ Select/Type the position here Position: ___________________________________________ Address: ________________________________________________ City ___________________ State ______ Zip __________ Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. Under penalties of perjury and as an authorized authority, I declare that this statement of change(s), has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Name/Title: ___________________________________ Signature: _________________________________ Date: _____________________ American LegalNet, Inc. www.FormsWorkflow.com