Agents Statement Of Change Of Registered Office Address {BE-12}

BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form BE-12) STATE OF NORTH CAROLINA Department of the Secretary of State AGENT222S STATEMENT OF CHANGE OF REGISTERED OFFICE ADDRESS Pursuant to 24755D-31 of the General Statutes of North Carolina, the undersigned submits the following for the purpose of changing the address of the registered office in the State of North Carolina of the entity named below: 1. The name of the entity is: 2. The name of the current Registered Agent is: Current Entity Information 3. The street address and county of the current Registered Office of the entity is: Number and Street: City: State: NC Zip Code: County: The mailing address if different from the street address of the current Registered Office of the entity is: Number and Street: City: State: NC Zip Code: County: New Entity Information 4. The street address and county of the New Registered Office of the entity is: Number and Street: City: State: NC Zip Code: County: The mailing address if different from the street address of the New Registered Office of the entity is: Number and Street: City: State: NC Zip Code: County: 5. The address of the entity222s registered office and the address of the business office of its registered agent, as changed, will be identical. 6. The undersigned certifies that the entity has been notified in writing of the change of address of the registered agent222s business office. 7. This statement will be effective upon filing, unless a date and./or time is specified: This is the day of , 20. (Name of Entity) (Signature) (Type or Print Name and Title) Notes: Filing Fee is $5.00. One executed statement must be filed with the Secretary of State. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form BE-12) AGENT222S STATEMENT OF CHANGE OF REGISTERED OFFICE ADDRESS INSTRUCTIONS FOR FILING (Form BE-12) Item 1 Enter the complete name of the entity exactly as it appears in the records of the Secretary of State. Item 2 Enter the complete street address and county of the current registered office exactly as it appears in the records of the Secretary of State. Item 3 Enter the complete mailing address of the registered office only if it is different from the street address shown in Item 2. Item 4 Enter the complete street address and county of the new registered office. Item 5 Enter the complete mailing address of the new registered office only if it is different from the street address shown in Item 4. Item 6 Enter the name of the registered agent exactly as it appears in the records of the Secretary of State. Item 7 See form. Item 8 See form. Item 9 The document will be effective on the date and at the time of filing, unless a delayed date or an effective time (on the day of filing) is specified. If a delayed effective date is specified without a time, the document will be effective at 11:59:59 p.m. on the day specified. If a delayed effective date is specified with a time, the document will be effective on the day and at the time specified. A delayed effective date may be specified up to and including the 90th day after the day of filing. Date and Execution Enter the date the document was executed. In the blanks provided enter: The name of the entity registered agent which is executing the statement; if the registered agent is an individual, leave blank. The signature of the registered agent or of the representative of the entity which is acting as the registered agent. The name of the registered agent or the name and the title of the above-signed representative. American LegalNet, Inc. www.FormsWorkFlow.com