Free Microsoft Word - CHANGE_OTH - Colorado

Document processing fee If document is filed on paper $10.00 If document is filed electronically Currently Not Available Fees & forms/cover sheets are subject to change. To file electronically, access instructions for this form/cover sheet and other information or print copies of filed documents, visit www.sos.state.co.us and select Business Center. Paper documents must be typewritten or machine printed.

ABOVE SPACE FOR OFFICE USE ONLY

Statement of Change Changing Information Other Than Principal Office Address or Registered Agent Information
filed pursuant to §7-90-305.5 and, if applicable, §7-90-604 or §7-90-804 of the Colorado Revised Statutes (C.R.S.)

ID number: 1. Entity name: 2. True name:
(if different from the entity name)

_____________________ ______________________________________________________

______________________________________________________

Complete lines 3 - 10 as applicable. You must complete section 11. 3. Document number:
(required for change(s) to 4, 5, 6, 7 and/or 8 below)

_____________________

4. Change of entity name of record (LLP, art. 61 LLLP or foreign entity only): New entity name: _____________________________________________________

5. Change of true name of record (LLP, art. 61 LLLP, general partnership or foreign entity only): New true name: ______________________________________________________

6. Change of jurisdiction of formation of record (foreign entity only): New jurisdiction of formation: ______________________________________________________

7. Change of entity form of record (foreign entity only): New entity form: ______________________________________________________

CHANGE_OTHER

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Rev. 03/05/2009

8. Other change(s) not provided for above:

If other information contained in the filed document is being changed, mark this box include an attachment stating the information to be changed and each such change. If other information is being added or deleted, mark this box stating each addition or deletion.

and

and include an attachment

9. Withdrawal of Statement of Registration of True Name: (if applicable, mark this box 10. (Optional) Delayed effective date: Notice: ______________________
(mm/dd/yyyy)

)

Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is such individual's act and deed, or that such individual in good faith believes such document is the act and deed of the person on whose behalf such individual is causing such document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent documents and the organic statutes, and that such individual in good faith believes the facts stated in such document are true and such document complies with the requirements of that Part, the constituent documents, and the organic statutes. This perjury notice applies to each individual who causes this document to be delivered to the Secretary of State, whether or not such individual is identified in this document as one who has caused it to be delivered. 11. The true name and mailing address of the individual causing this document to be delivered for filing are ____________________ ______________ ______________ _____
(Last) (First) (Middle) (Suffix)

______________________________________________________
(Street number and name or Post Office Box information)

______________________________________________________ __________________________ _____
(City) (Province ­ if applicable) (State) (Country)

____________________
(ZIP/Postal Code)

_______________________ ______________.
(If applicable, adopt the following statement by marking the box and include an attachment.)

This document contains the true name and mailing address of one or more additional individuals causing the document to be delivered for filing. Disclaimer: This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should be addressed to the user's legal, business or tax advisor(s).

CHANGE_OTHER

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Rev. 03/05/2009