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Form Ar: 0009 - Corporation Statement Of Change Of Known Place Of Business Or Statutory Agent Page 2

Corporation Name:

File Number:

(B)

The address of the statutory agent in ARIZONA is to be changed. The new

address of the statutory agent is:

___________________________________________________________

and the statutory agent has given the Corporation written notice of this change.

ARS §10-140 requires that changes to corporation(s) be executed by an officer of the corporation, whose file is to be

changed.

DATED this ____ day of ________________________, __________

________________________________________________________

[Name of Corporation]

By__________________________________

__________________________________

[Name]

[Title]

____________________________________

[Statutory Agent]*

*(Statutory Agent must sign only if changing address.)

If the agent has a P.O. box, then they must also provide a physical location/address where service of

process on the corporation can occur. Also, personal mail boxes (PMB) are unacceptable for a physical

address, but fine for a mailing address.

Acceptance of Appointment

By Statutory Agent**

The undersigned hereby acknowledges and accepts the appointment as statutory agent of the

above-named corporation effective this ______ day of ____________________,_______

Signature:____________________________________________

Printed Name:________________________________________

**(required only if a new statutory agent is being appointed)

AR: 0009

Rev: 1/2005

Page 2 of 2

Form Ar: 0009 - Corporation Statement Of Change Of Known Place Of Business Or Statutory Agent Page 2