Statement of Change of Principal Address or Statutory Agent

Limited Liability Company Statement of Change of Known Place of Business, Statutory Agent, or Statutory Agents Street Address or Change of Address of a Member or Manager (A.R.S. 29-605 and 29-605.01) FILING FEE $5.00 (A.R.S. 29-851) It is important that the information you provide on this form correct. To obtain the correct inform be ation about the Limited Liability Companys current known place of business and statutory agent, consult the Corporations Divisions Record Section at (602) 542-3026 or the Divisions website at www.cc.state.az.us/corp. 1. The exact name of the Limited Liability Company (LLC) currently on file with the Arizona Corporation Commission (ACC) is: ________________________________________________________________________________ 2. The ACC file number is: ______________________________________ 3. The current address of the LLCs known place of business on file with the ACC is: ______________________________________ ______________________________________ ______________________________________ 4. The name and street address* of the current statutory agent on file with the ACC are: ______________________________________ ______________________________________ ______________________________________ ______________________________________ 5. If the LLC was not organized in Arizona, the address of the office required to be maintained in the state of its organization or, if not so required, of the principal office of the foreign LLC is: ______________________________________ ______________________________________ ______________________________________ 6. Is the known place of business in Arizona to be changed? Q No. Q Yes, and the address of the new place of business is: ______________________________________ ______________________________________ ______________________________________ * street address must be a physical address. P.O. box addresses will not be accepted. LL:0006 1 of 3 Rev. 9/04 <<<<<<<<<********>>>>>>>>>>>>> 2LLC Name ________________________________________ ACC File Number _________________7. Is the statutory agent to be changed? Q No. Q Yes, and the name and street address* of the new statutory agent are: ______________________________________ ______________________________________ ______________________________________ ______________________________________ 8. Is the street address of the current statutory agent to be changed? Q No. Q Yes, the new street address* of the current statutory agent is: ______________________________________ ______________________________________ ______________________________________, and the statutory agent has given the LLC written notice of this change.9. Is the address of one or more of the LLCs members or managers to be changed? Q No. Q Yes. If you checked yes, you must complete the following information for each member or manager whose address is to be changed:Name: ____________________________________, Member or Manager (circle one)Current New Address: ________________________________ Address: _______________________________ ________________________________ _______________________________ ________________________________ _______________________________ Name: ____________________________________, Member or Manager (circle one)Current New Address: ________________________________ Address: _______________________________ ________________________________ _______________________________ ________________________________ _______________________________Name: ____________________________________, Member or Manager (circle one)Current New Address: ________________________________ Address: _______________________________ ________________________________ _______________________________ ________________________________ _______________________________* street address must be a physical address. P.O. box addresses will not be accepted.LL:0006 2 of 3 Rev. 9/04 <<<<<<<<<********>>>>>>>>>>>>> 3LLC Name ________________________________________ ACC File Number ____________________ A.R.S 29-605and 29-605.01 require that changes to limited liability companies be executed by amember/manager of the LLC. DATED this _____ day of __________________________, _________. _____________________________________________________________________ Name of LLC By ________________________________________________ ___________________________________________________ Print Name Title ___________________________________________________ Statutory Agent (must sign only if agent is changing address) Acceptance of Appointment By Statutory Agent (required only if a new statutory agent is being appointed) The undersigned hereby acknowledges and accepts the appointment as statutory agent of the above-named limited liability company effective this ______ day of _____________, __________. Signature: ___________________________________ Printed Name: ________________________________ LL:0006 3 of 3 Rev. 9/04