Wyoming Secretary of State
State Capitol Building, Room 110
th
200 West 24
Street
For Office Use Only
Cheyenne, WY 82002-0020
Ph. 307.777.7311
Fax 307.777.5339
Email: business@state.wy.us
Statement of Change of Registered Agent and/or Registered Office
By Business Entity
1. Name of the business entity:
2. Name of its current registered agent and street address of its current registered office:
Current Registered Agent:
Current Registered Office:
3. Name of its new registered agent and physical Wyoming address of its new registered office:
New Registered Agent:
For consistency the Secretary of State’s Office will only keep one version of the agent’s name on file.
New Registered Office:
4. I hereby certify that the new registered office and the registered agent comply with the requirements of W.S. 17-28-101
through W.S. 17-28-111.
5. The mailing address should be changed to reflect the new registered office address.
Yes
No
6. The principal address should be changed to reflect the new registered office address.
Yes
No
7. A separate notice must be provided to change the mailing and/or principal office address if different than the new registered
office address.
8. After the changes are made, the street address of its registered office and the business office of its registered agent will be
identical.
Date:
Signature: ______________________________________________
(mm/dd/yyyy)
(Shall be executed by an authorized individual.)
Print Name:
Contact Person:
Title:
Daytime Phone Number:
Email:
Checklist
Filing Fee: Nonprofit Corporation - $3.00 (by statute); All other business entities - No Fee
The Statement must be accompanied by a written consent to appointment executed by the registered agent.
Please submit one originally signed document and one exact photocopy of the filing.
Please review form prior to submitting to the Secretary of State to ensure all areas
have been completed to avoid a delay in the processing of your documents.
RA-RO ChangeByEntity – 5/21/2009