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Statement of Change of Mailing Address of Surviving Entity (North Carolina)

This form is a statement of change of mailing address for a surviving business entity in North Carolina. The form provided here is simply a sample of what the actual Form B-15 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 MAILING ADDRESS
OF SURVIVING ENTITY*

1. Pursuant to N.C.Gen. Stat. ยงยง 55-15-21(a)(4), 55A-11-09(d)(3) 55A-15-21(a)(4), 57C-7- 12(a)(4) and 59-909(a)(4), as applicable, notice is hereby given by the undersigned business entity that its mailing address has changed

from _________________________________ (mailing address previously filed with the Secretary of State)

to ____________________________________ (new mailing address).

2. This Statement will be effective upon filing, unless a delayed date and/or time is specified: _______________________

This the ____ day of _____________, 2000.

____________________________________
Name of Entity

____________________________________
Signature

____________________________________
Type or Print Name and Title


NOTES:

1. Filing fee is $10. This document and one exact or conformed copy of this Statement must be filed with the Secretary of State.

* This form should only be used by the surviving entity in a merger to notify the Secretary of State of a change in its mailing address after Articles of Merger or an Application for Certificate of Withdrawal by Reason of Merger, Consolidation or Conversion have been filed. This form should not be used to change the registered office address. A Statement of Change of Registered Office and/or Registered Agent should be used for that purpose.

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