Corporation Statement Of Change Form Page 2
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1
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3CURRENT OR EXISTING
5.
STATUTORY AGENT – list the name and addresses of the
statutory agent as shown in the records of the Arizona Corporation Commission before any
changes (this is the existing statutory agent):
5.1 REQUIRED – list the name and physical
5.2 REQUIRED – list the mailing address
or street address (not a P.O. Box) in
(if one exists in A.C.C. records) in Arizona
Arizona of the existing statutory agent:
of the existing Statutory Agent:
Statutory Agent Name
Attention (optional)
Attention (optional)
Address 1
Address 1
Address 2 (optional)
Address 2 (optional)
City
State
Zip
City
State
Zip
5.3
CHANGE IN EXISTING STATUTORY AGENT NAME ONLY – if the name only of
the existing statutory agent listed in number 5.1 above has changed, but a new
agent has not been appointed, check the box and give the new name of the
existing statutory agent below:
__________________________________________________________________
5.4
CHANGE IN EXISTING STATUTORY AGENT ADDRESS – check all that apply
and follow instructions:
STREET ADDRESS CHANGED – complete number 5.5.
MAILING ADDRESS CHANGED – complete number 5.6.
5.5 NEW STREET ADDRESS – give the NEW
5.6 NEW MAILING ADDRESS – give the NEW
physical or street address (not a P.O. Box)
mailing address in Arizona of the existing
in Arizona of the existing statutory agent:
statutory agent (can be a P.O. Box):
Attention (optional)
Attention (optional)
Address 1
Address 1
Address 2 (optional)
Address 2 (optional)
City
State
Zip
City
State
Zip
C016.001
Arizona Corporation Commission – Corporations Division
Rev: 2010
Page 2 of 3
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