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Statement Of Change Of Registered Office And/Or Registered Agent (North Carolina)

This form is to change a registered corporate office and/or agent in North Carolina. The form provided here is simply a sample of what the actual Form BN-06 looks like.

State of North Carolina
Department of the Secretary of State

CORPORATIONS DIVISION
P. O. BOX 29622
RALEIGH, NC 27626-0622


STATEMENT OF CHANGE OF REGISTERED OFFICE AND/OR REGISTERED AGENT

Pursuant to §55-5-02, §55A-5-02, §55-15-08, and §55A-15-08 of the General Statutes of North Carolina, the undersigned corporation submits the following for the purpose of changing its registered office and/or registered agent in the State of North Carolina.

INFORMATION CURRENTLY ON FILE

The name of the corporation is: _____________________________________

The street address and county of the corporation's registered office currently on file is:

Number and Street: _____________________________________

City _____________________________________

State _____________________________________

Zip Code: _____________________________________

County: ___________________________________

The mailing address if different from the street address of the registered office currently on file is:

___________________________________

The name of the current registered agent is: _________________________

NEW INFORMATION

1. The street address and county of the new registered office of the corporation is:
(complete this item only if the address of the registered office is being changed)

Number and Street: ___________________________________

City ___________________________________

State ___________________________________

Zip Code: ___________________________________

County: ___________________________________

2. The mailing address if different from the street address of the new registered office is:
(complete this item only if the address of the registered office is being changed)

___________________________________

3. The name of the new registered agent and the new agent's consent to appointment appears below:
(complete this item only if the name of the registered agent is being changed)

___________________________________

Type or Print Name of New Agent ___________________________________

* Signature & Title ___________________________________

4. The address of the corporation's registered office and the address of the business office of its registered agent, as changed, will be identical.

5. This statement will be effective upon filing, unless a date and/or time is specified:

_____________________________________

This is the _____day of _______________, 20____.

________________________________________ Corporation Name

________________________________________ Signature

________________________________________ Type or Print Name and Title

* Instead of signing here, the new registered agent may sign a separate written consent to the appointment, which must be attached to this statement.

Note: 1.

Filing fee is $5.00. This document and one exact or conformed copy must be filed with the Secretary of State.

-----------------------------
INSTRUCTIONS FOR FILLING OUT THIS FORM
-----------------------------

Under "Information Currently On File" section:

Enter the name of the corporation and the name and address of the registered agent and registered office as they currently appear on the records of the Secretary of State.

Under "New Information" section:

Item 1 Enter the complete street address and county of the new registered office.

Item 2 Enter the complete mailing address only if it is different from the street address shown in Item 1.

Item 3 Enter the new registered agent's name, signature, and title (if the new registered agent is a corporation). The registered agent must be a North Carolina resident, an existing domestic business or nonprofit corporation, or a foreign business or nonprofit corporation authorized to do business or conduct affairs in North Carolina (other than you own corporation).

Item 4 See form.

Item 5 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 corporation.

· An officer of the corporation must sign.

· The name and the title of the above-signed representative.

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