Corporation Statement Of Change Form Page 3

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NEW

STATUTORY AGENT – if a new statutory agent is being appointed, check the box

and complete the following for the NEW statutory agent:

6.1 REQUIRED – give the name (can be an

6.2 OPTIONAL – mailing address in Arizona of

individual or an entity) and physical or

NEW Statutory Agent (can be a P.O. Box):

street address (not a P.O. Box) in Arizona

of the NEW statutory agent:

Statutory Agent Name

Attention (optional)

Address 1

Address 2 (optional)

City

State

Zip

City

State

Zip

6.3

REQUIRED – if you are appointing a new statutory agent, the

Statutory Agent Acceptance

form M002 must be submitted along with this Statement of Change form.

SIGNATURE – see

Instructions C016i

for who is authorized to make changes:

If the person signing this form is the existing statutory agent changing its own address, then by the

signature appearing below, the existing statutory agent certifies under penalty of perjury that he or

she has given the corporation named in number 1 above written notice of the address change.

By checking the box marked "I accept" below, I acknowledge under penalty of perjury that this

document together with any attachments is submitted in compliance with Arizona law.

I ACCEPT

Signature

Printed Name

Date (mm/dd/yyyy)

REQUIRED – check only one:

I am the Chairman of the Board

I am a duly-authorized Officer of

I am a Statutory Agent

changing only my own address

of Directors of the corporation

the corporation filing this document.

and/or my own name.

filing this document.

Filing Fee: None (regular processing)

Mail:

Arizona Corporation Commission - Corporate Filings Section

Expedited processing – add $35.00 to filing fee.

1300 W. Washington St., Phoenix, Arizona 85007

All fees are nonrefundable - see Instructions.

Fax:

602-542-4100

Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain

to the individual needs of your business.

All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.

If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.

C016.001

Arizona Corporation Commission – Corporations Division

Rev: 2010

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