Statement Of Change Of Registered Agent And Or Registered Office {NFP-105.10-105.20}

FORM NFP 105.10/105.20 (rev. Dec. 2003) STATEMENT OF CHANGE OF REGISTERED AGENT AND/OR REGISTERED OFFICE General Not For Profit Corporation Act Secretary of State Department of Business Services 501 S. Second St., Rm. 350 Springfield, IL 62756 217-782-7808 www.cyberdriveillinois.com Remit payment in the form of a check or money order payable to Secretary of State. Print Reset Save ____________________________________ File #______________________________ 1. Corporate Name: _______________________________________________________________________________ 2. State or Country of Incorporation: __________________________________________________________________ 3. Name and Address of Registered Agent and Registered Office as they appear on the records of the Office of the Secretary of State (before change): First Name Number City Middle Name Street Last Name -------- Submit in duplicate -------- Type or Print clearly in black ink -------- Do not write above this line -------- Filing Fee: $5 Approved: ___________ Registered Agent: _______________________________________________________________________________ Suite # (P.O. Box alone is unacceptable) County Registered Office: _______________________________________________________________________________ ZIP Code Registered Office _______________________________________________________________________________ 4. Name and Address of Registered Agent and Registered Office shall be (after all changes herein reported): First Name Number City Middle Name Street Last Name Registered Agent: _______________________________________________________________________________ Suite # (P.O. Box alone is unacceptable) County Registered Office: _______________________________________________________________________________ ZIP Code Registered Office _______________________________________________________________________________ 5. The address of the registered office and the address of the business office of the registered agent, as changed, will be identical. 6. The above change was authorized by: ("X" one box only) a. q Resolution duly adopted by the board of directors. (See Note 4 on reverse.) b. q Action of the registered agent. (See Note 5 on reverse.) SEE REVERSE FOR SIGNATURE(S). Printed by authority of the State of Illinois. January 2015 -- 1 -- C 321.8 7. If authorized by the board of directors, sign here. (See Note 4 below.) The undersigned corporation has caused this statement to be signed by a duly authorized officer who affirms, under penalties of perjury, that the facts stated herein are true and correct. Dated _______________________________ , _____ Month & Day Year Any Authorized Officer's Signature Name and Title (type or print) ______________________________________ ______________________________________ ________________________________________________ Exact Name of Corporation If change of registered office by registered agent, sign here. (See Note 5 below.) The undersigned, under penalties of perjury, affirms that the facts stated herein are true and correct. Dated _______________________________ , _____ Month & Day Year ________________________________________________ Signature of Registered Agent of Record ________________________________________________ Name (type or print) If Registered Agent is a corporation, Name and Title of officer who is signing on its behalf. 1. The registered office may, but need not be, the same as the principal office of the corporation. However, the registered office and the office address of the registered agent must be the same. 2. The registered office must include a street or road address (P.O. Box alone is unacceptable). 3. A corporation cannot act as its own registered agent. NOTES 4. Any change of registered agent must be by resolution adopted by the board of directors. This statement must be signed by a duly authorized officer. 5. The registered agent may report a change of the registered office of the corporation for which he/she is a registered agent. When the agent reports such a change, this statement must be signed by the registered agent. If a corporation is acting as the registered agent, a duly authorized officer of such corporation must sign this statement. American LegalNet, Inc. www.FormsWorkFlow.com