Free CORPORATION - Arizona

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CORPORATION STATEMENT OF CHANGE OF KNOWN PLACE OF BUSINESS OR STATUTORY AGENT Pursuant to A.R.S. §§10-502, 10-1508, 10-11508 & 10-3502

NOTE: It is critical that the Corporation Commission receive information about the existing (old) official address and/or agent data as well as the new address or agent data. Please check with our Customer Call Center (602) 542-3026 or our web site, www.azcc.gov/divisions/corporations to obtain the correct information.

1. The exact name of the corporation on file with the Arizona Corporation Commission (ACC) is: ______________________________________________________________________________ 2. The ACC file number is_________________________________ 3. The known place of business currently on file with the ACC is: ________________________________________ ________________________________________ ________________________________________ 4. The name and street address of the current statutory agent on file with the ACC is: _________________________________________ _________________________________________ _________________________________________ 5. (A) The known place of business in ARIZONA is to be changed. The street address of the new known place of business is: ________________________________________________________________ ________________________________________________________________ (B) Foreign corporations only: The known place of business in the State or Country in which the corporation was incorporated is to be changed. The new foreign address is: ________________________________________________________________ ________________________________________________________________ Indicate which address the Annual Report should be mailed to: 5(A)________ 5(B)________ 6. (A) The address of the statutory agent is to be changed.* (If the statutory agent has a P.O.
box or personal mail box (PMB) then he/she must also provide a physical location/address).

___________________________________________________________ ___________________________________________________________ ___________________________________________________________
If only changing the statutory agent's address, the statutory agent is the only individual who must sign this statement. * By signing this document, the statutory agent acknowledges that he/she has given the corporation written notice of this change.
AR: 0009 Rev: 10/2007 Arizona Corporation Commission Corporations Division

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Corporation Name: ________________________________

File Number:________________

(B)

The statutory agent in ARIZONA is to be changed. The name and street address of the new statutory agent is: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

The new statutory agent must accept his/her appointment as the new statutory agent. Acceptance of Appointment By Statutory Agent**
**(required only if a new statutory agent is being appointed)

The undersigned hereby acknowledges and accepts the appointment as statutory agent of the above-named corporation effective this _____ day of _______________,_______ Signature:______________________________________________ Printed Name:_______________________Title: _______________ ______________________________________________________
If signing on behalf of a company, please print the company name here.

Statutory agent must sign only if changing his/her address (Item 6(A)).

Changes to corporation(s) other than changes to a statutory agent's address, must be executed by an officer of the corporation.

Dated this ______ day of ____________, _________ Dated this ______ day of ____________, _________ Signature: __________________________________ Signature: __________________________________ Printed Name: _______________________________ Printed Name: _______________________________ __________________________________________ Title: _______________________________________
If signing on behalf of a company, please print the company name here.

AR: 0009 Rev: 10/2007

Arizona Corporation Commission Corporations Division

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