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Nonprofit Corporation's Statement Of Change Of Principal Office (North Carolina)

This is a statement of a nonprofit corporation's change of principal office in North Carolina. The form provided here is simply a sample of what the actual Form N-12 looks like.

State of North Carolina
Department of the Secretary of State

NONPROFIT CORPORATION'S STATEMENT OF CHANGE OF PRINCIPAL OFFICE

Pursuant to §55A-5-02.1(b) of the General Statutes of North Carolina, the undersigned nonprofit corporation does hereby submit the following for the purpose of changing its principal office address currently on file with the Secretary of State.

INFORMATION CURRENTLY ON FILE

The name of the corporation is: ______________________________

The street address and county of the principal office of the corporation currently on file is:

Number and Street: _________________________________

City, State, Zip Code: _________________________________

County: _________________________________

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

_________________________________

_________________________________


NEW INFORMATION

1. The street address and county of the new principal office of the corporation is:

Number and Street: _________________________________

City, State, Zip Code: _________________________________

County: _________________________________

2. The mailing address if different from the street address of the new principal office is:

_________________________________

_________________________________

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

_________________________________

This is the __________________ day of_______________, 20_____.

__________________________________________
Name of Corporation

__________________________________________
Signature

__________________________________________
Type or Print Name and Title

NOTE:

1. Filing fee is $5. This statement and one exact or conformed copy of it must be filed with the Secretary of State.


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INSTRUCTIONS FOR FILLING IN THIS FORM
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Under "Information Currently On File" section, enter the name of the corporation and the address of the principal 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 principal office of the corporation.

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

Item 3 The document will be effective on the date and at the time of filing, unless a delayed date and/or time is specified. If a delayed effective date and time is specified, the document will be effective on that date and time. A delayed effective date may be specified up to and including the 90th day after the day of filing. If a delayed effective date is specified without a time, the document will be effective at 11:59:59 p.m.

Date and Execution

Enter the date the document was executed.

In the blanks provided enter:

· The name of the corporation executing the statement.

· The signature of the representative of the corporation (may be a chairman or presiding officer of the board of directors or any officer of the corporation).

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

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