Amendment Of Statement Of Appointment Of Agent {NA-02}

BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised August 2017) Form NA-02 INFORMATION CURRENTLY ON FILE STATE OF NORTH CAROLINA DEPARTMENT OF THE SECRETARY OF STATE AMENDMENT OF STATEMENT OF APPOINTMENT OF AGENT Pursuant to 24759B-11 of the General Statutes of North Carolina, the undersigned entity submits the following for the purpose of amending its statement of appointment of agent. The name of the entity is: The street address and county of the entity222s office currently on file is: Number and Street: City, State, Zip Code: County: The mailing address if different from the street address of the office currently on file is: The name of the current agent is: 1. The street address and county of the new office of the entity 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 office is: (Complete this item only if the address of the office is being changed) 3. The name of the new agent and the new agent222s consent to appointment appears below: (complete this item only if the name of the agent is being changed) Type or Print Name of New Agent * Signature & Title 4. This statement will be effective upon filing, unless a date and/or time is specified: This is the day of , 20. Entity Name Signature Type or Print Name and Title Notes: Filing fee is $5.00. This document must be filed with the Secretary of State. * Instead of signing here, the new agent may sign a separate written consent to the appointment, which must be attached to this statement. NEW INFORMATION American LegalNet, Inc. www.FormsWorkFlow.com