Form 635_0119 - Statement Of Change Of Registered Office And/or Registered Agent - 2011
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1
2STATEMENT OF CHANGE
MATT SCHULTZ
OF REGISTERED OFFICE
Secretary of State
AND/OR
State of Iowa
REGISTERED AGENT
Pursuant to Iowa law, the undersigned submits this Statement to change the business entity’s registered office and/or registered
agent in Iowa. Read the instructions on the back of this form before completing the information and signing below.
1.
:
The name of the business entity is
2
:
. The address of the CURRENT registered OFFICE, as indicated on the Secretary of State’s records is
______________________________________________________________________________________
street address
city
state
zip
3.
The address of the NEW registered OFFICE is:
______________________________________________________________________________________
street address
city
state
zip
4.
The name of the CURRENT registered AGENT as indicated on the Secretary of State’s records is:
______________________________________________________________________________________
(If more than one AGENT is registered, indicate which one is being replaced.)
5.
: ___________________________________________________
The name of the NEW registered AGENT is
6.
If the REGISTERED AGENT has changed, the NEW Registered Agent must sign here, consenting to their
appointment, or attach their written consent to this form.
__________________________________________________
Signature of NEW Registered Agent
Complete ONLY if the Registered Agent changes.
7.
If the REGISTERED AGENT changes the street address of their business office on this form, the Registered Agent
must sign here indicating that NOTICE of the change has been given to the business entity.
_______________________________________
Signature of Registered Agent
Complete ONLY if the Registered Agent changes the street address of their business office.
8
. After any/all change(s) are made, the street address of the registered office and the street address of the business
office of the registered agent will be identical.
9.
_________________________________
: _______________
Signature by authorized* representative:
Date
*See instruction #9 on back
: _____________________________________________ (
)__________________
PRINT Name and Title
Name and Title
Telephone Number
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