Free 635_08_1.p65 - Iowa

MICHAEL A. MAURO Secretary of State State of Iowa

STATEMENT OF CHANGE OF REGISTERED OFFICE AND/OR REGISTERED AGENT
(Limited Liability Company - Iowa Code Chap 489)

Pursuant to section 114 of the Iowa Revised Uniform Limited Liability Company Act, the undersigned submits this Statement to change the limited liability's registered office and/or registered agent in Iowa. Read the INSTRUCTIONS on the back of this form before completing the information and signing below.

1. The NAME of the limited liability company is: ____________________________________________________________ .

2. The street and mailing address of the CURRENT registered OFFICE as indicated on the Secretary of State's records is:
__________________________________________________________________________________________________ .
street city state zip

3. The street and mailing address of the NEW registered OFFICE is:
__________________________________________________________________________________________________ .
street city state zip

4. The name of the CURRENT REGISTERED AGENT as indicated on the Secretary of State's records is:
__________________________________________________________________________________________________ .

5. The name of the NEW REGISTERED AGENT is:__________________________________________________________ .

6. Signature: ____________________________________________________________________ Date: _______________
*See instruction #6 on back

PRINT Name and Title: ___________________________________________________________________________________
Name and Title

635_08_1 rev. 12/08

INSTRUCTIONS FOR

STATEMENT OF CHANGE OF REGISTERED OFFICE AND/OR REGISTERED AGENT
Limited Liability Companies must submit a Statement of Change form to change the Registered Office and/or Registered Agent in Iowa. It is important to read these INSTRUCTIONS before you fill out the Change form. The numbers on these instructions correspond to the numbering on the form. PLEASE PRINT LEGIBLY.

1.

Print the full name of the Limited Liability Company on line 1.

2. & 3. Print the street and mailing address, city, state and zip code of the CURRENT and the NEW Registered Office. 4. & 5. Print the full name of the CURRENT and the NEW Registered Agent. 6.
Line 6 of the Statement of Change form should be signed by a person authorized by the company. It must also state the date signed, the person's name, and the capacity in which the person signed.

NOTES: 1. There is NO FILING FEE. 2. One copy is to be delivered or faxed to the Secretary of State for filing. 3. The information you provide will be open to public inspection under Iowa Code chapter 22.11

SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, Iowa 50319 Phone: (515) 281-5204 FAX: (515) 281-7142 or (515) 242-5953 Website: www.sos.state.ia.us

635_08_1 rev. 12/08