Commercial Registered Agent Change Of Name Or Address Form - 2012

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COMMERCIAL REGISTERED AGENT
Secretary of State Office
500 E Capitol Ave
RECEIPT NO ___________________
CHANGE OF NAME OR ADDRESS
Pierre, SD 57501
(605)773-4845
Please Type or Print Clearly in Ink
Clear Form
Original
Photocopy
Please submit one
and one
FILING FEE: $10
per Entity Represented
HELP
SECRETARY OF STATE
Payable to
The Commercial Registered Agent (CRA) identified below submits to the Secretary of State the following change of name
or address.
1. The Commercial Registered Agent CRA# _____________________________________________________________
2. The current CRA name ___________________________________________________________________________
The new CRA name _____________________________________________________________________________
3. The current address on file
______________________________________________________________________________________________
Street Address
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional)
City
State
ZIP+4
The new address
______________________________________________________________________________________________
Street Address (Required to be a South Dakota Address)
City
State
ZIP+4
______________________________________________________________________________________________
Mailing Address (Optional – Required to be a South Dakota Address)
City
State
ZIP+4
4. The jurisdiction of organization _____________________________________________________________________
The new jurisdiction _____________________________________________________________________________
5. The type of organization __________________________________________________________________________
New type of organization __________________________________________________________________________
The statement of change shall be signed by or on behalf of the commercial agent.
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Statementofchangecomm April 2012

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