Free corp 59a - Missouri

State of Missouri
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This form is designed to be filled out online for your convenience. Please read the instructions carefully. Complete the necessary information, print, sign and mail.

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Robin Carnahan, Secretary of State
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Corporations Division PO Box 778 / 600 W. Main St., Rm. 322 Jefferson City, MO 65102

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Statement of Change of Business Office Address and Registered Office Address of a Registered Agent of a Foreign or Domestic For Profit or Nonprofit Corporation or a Limited Liability Company
Instructions 1. This form is to be used by either a for profit or nonprofit corporation or a limited liability company to change the address of its existing registered agent. 2. There is a $10.00 fee for filing this statement. 3. PO Box may only be used in conjunction with a physical street address. 4. Agent and address must be in the State of Missouri. 5. The corporation may not act as its own agent. Charter #: The undersigned registered agent, for the purpose of changing the address of its business office in Missouri, and thereby changing the registered office address of the named business entity, represents that: 1. The name of the business entity is: 2. The name of the registered agent is: 3. The address, including street number, of the present business office of the registered agent (and the registered office of the business entity) is:

4. The address, including street number, of the business office of the registered agent (and the registered office of the business entity) is hereby changed to:

5. Notice in writing of the change of the registered office address has been mailed by the registered agent to the business entity named above. 6. The address of the registered office of the business entity named above and the business office of the registered agent, as changed, is identical. In Affirmation thereof, the facts stated above are true and correct: (The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575.040. RSMo)

Authorized Signature of Registered Agent

Name and address to return filed document: Name: Address: City, State, and Zip Code:
Corp. 59A (05.2009)

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Address (PO Box may only be used in conjunction with a physical street address)

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