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STATE OF OREGON Corporation Division ­ Notary 255 Capitol Street NE, Suite 151 Salem, OR 97310-1327 503-986-2593 FAX 503-986-2300 FilingInOregon.com/notary

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NOTARY PUBLIC ADDRESS CHANGE
COMPLETE ALL SECTIONS. PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK.

Notary Commission No:

Commission Expiration:

Notary Commission Name:

New Address where notary materials should be mailed
(Include city, state, zip)

Old Mailing Address:

New Resident Street Address:
(If different from mailing address above)

Old Resident Street Address:

New Business Name and Address:

Old Business Name and Address:

Daytime Phone Number & Extension:

Home Phone Number:

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Signature as it appears on Commission

Effective date of change

502 (Rev. 11/02)