Free Corp. 59 - Missouri

State of Missouri
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Robin Carnahan, Secretary of State
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Statement of Change of Registered Agent and/or Registered Office By 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 either or both the name of its registered agent and/or 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 #: 1. The name of the business entity is 2. The address, including street and number, of its present registered office (before change) is

3. The address, including street and number, of its registered office is hereby changed to:

4. The name of its present registered agent (before change) is: 5. The name of the new registered agent is: Authorized signature of new registered agent must appear below:

6. The address of its registered office and the address of the business office of its registered agent, as changed, will be identical. 7. The change was duly authorized by the business entity named above. 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 officer or, if applicable, chairman of the board Printed Name

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Name and address to return filed document: Name: Address: City, State, and Zip Code:
Corp. 59 (11/2008)

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Corporations Division PO Box 778 / 600 W. Main St., Rm. 322 Jefferson City, MO 65102

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Address

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

City/State/Zip

(May attach separate originally executed written consent to this form in lieu of this signature)

Date