Doing Business As (Dba) Registration Information Change Form - Utah Department Of Commerce
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1Link to Doing Business As (DBA) Registration Information Change Form Addendum
This form must be type written or computer generated.
State of Utah
Business Registration - Optional Inclusion of Ownership Data
DEPARTMENT OF COMMERCE
Instructions
Division of Corporations & Commercial Code
Doing Business As (DBA) Registration Information Change Form
Print Form
Non-Refundable Processing Fee: $12.00
Clear Form
_________________________
Entity File Number:
___________________________________________________________________________________________
Entity Name:
For each Yes button that you mark the question will appear below for you to fill out.
1). Do you want to Change the Business Purpose?
Yes
No
1). If Yes, what is the new Business Purpose? ___________________________________________________________________________
2). Do you want to Change the Registered Agent or the Address of the Registered Agent?
Yes
No
2). If Yes, who is the new Registered Agent, or the new Address of the Registered Agent?
What is a commercial registered agent?
Is the registered agent a
commercial registered
agent?
YES
NO
If Yes, is the
commercial registered agent
an:
Individual
Entity
If an individual, what is the name of the individual (First, Middle, Last): __________________________________________
________________________________________
What is the Commercial Registered Agent Registration Number? (required): _
Registered Agent Name: __________________________________________________________________________________
I hereby accept appointment as Registered Agent for the above named business entity.
The Registered Agent must sign here after the form is printed
Signature of Registered Agent (Required): __________________________________________
__________________________________________________________
Address of the Registered Agent:
Utah Street Address Required, PO Boxes can be listed after the Street Address
City: ________________________________________________________________
State UT
Zip: _______________
3). Do you want to Change the Principal Address of the Business Entity?
Yes
No
3). If Yes, what is the new Principal Address?
________________________________________________ City ___________________ State ______ Zip __________
Address:
4). Do you want to Add individuals to the Business Entity?
Yes
No
4). If Yes, who do you want to Add to the Business Entity and what Position will they hold?
Select/Type the position here
Name: ____________________________________________
Position: ___________________________________________
________________________________________________ City ___________________ State ______ Zip __________
Address:
Select/Type the position here
Name: ____________________________________________
Position: ___________________________________________
________________________________________________ City ___________________ State ______ Zip __________
Address:
5). Do you want to Remove individuals from the Business Entity?
Yes
No
5). If Yes, who do you want to Remove from the Business Entity and what Position do they hold?
Select/Type the position here
Name: _________________________________________
Position: ___________________________________________
Select/Type the position here
Name: _________________________________________
Position: ___________________________________________
6). Do you want to Change the Address of the Business Entity’s Principal(s)?
Yes
No
6). If Yes, who is the Principal(s) whose Address you wish to Change?
Select/Type the position here
Name: ____________________________________________
Position: ___________________________________________
________________________________________________ City ___________________ State ______ Zip __________
Address:
Select/Type the position here
Name: ____________________________________________
Position: ___________________________________________
________________________________________________ City ___________________ State ______ Zip __________
Address:
Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use
the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
Under penalties of perjury and as an authorized authority, I declare that this statement of change(s), has been examined by me and is, to the best of
my knowledge and belief, true, correct and complete.
Sign here after printing form
Name/Title: ___________________________________ Signature: _________________________________ Date: ____________________
Mailing/Faxing Information:
Division's Website:
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