Corporation Registration Information Change Form

State of Utah Department of Commerce Division of Corporations & Commercial Code Corporation Registration Information Change Form Non-Refundable Processing Fee: $15.00 Entity File Number: _________________________ Entity Name: ___________________________________________________________________________________________ For each Yes button that you mark the question will appear below for you to fill out. 1). Do you want to Change the Business Purpose? Yes No 1). If Yes, what is the new Business Purpose? ___________________________________________________________________________ 2). Do you want to Change the Registered Agent or the Address of the Registered Agent? 2). If Yes, who is the new Registered Agent, or the new Address of the Registered Agent? Yes No ______________________________________________________________________________________________ The address must be listed if you have a non-commercial registered agent. See instructions for further details. Address of the Registered Agent: __________________________________________________________________ Utah Street Address Required, PO Boxes can be listed after the Street Address City _____________________________________________________________________________ State UT 3). Do you want to Change the Principal Address of the Business Entity? 3). If Yes, what is the new Principal Address? Yes Zip __________ No Address: ________________________________________________ City ___________________ State ______ Zip __________ 4). Do you want to Add individuals to the Business Entity? 4). If Yes, who do you want to Add to the Business Entity and what Position will they hold? Name: ____________________________________________ Name: ____________________________________________ Position: ___________________________________________ Position: ___________________________________________ Address: ________________________________________________ City ___________________ State ______ Zip __________ Address: ________________________________________________ City ___________________ State ______ Zip __________ 5). Do you want to Remove individuals from the Business Entity? 5). If Yes, who do you want to Remove from the Business Entity and what Position do they hold? Name: _________________________________________ Name: _________________________________________ Name: _________________________________________ Position: ___________________________________________ Position: ___________________________________________ Position: ___________________________________________ Yes No Yes No Yes No 6). Do you want to Change the Address of the Business Entity's Principal(s)? 6). If Yes, who is the Principal(s) whose Address you wish to Change? Name: ____________________________________________ Position: ___________________________________________ Address: ________________________________________________ City ___________________ State ______ Zip __________ Name: ____________________________________________ Position: ___________________________________________ Address: ________________________________________________ City ___________________ State ______ Zip __________ Optional Inclusion of Ownership Information: This information is not required. Is this a female owned business? Yes No Is this a minority owned business? Yes No If yes, please specify: _____________________________________ Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. Under penalties of perjury and as an authorized authority, I declare that this statement of change(s), has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Name/Title: ___________________________________ Signature: _________________________________ Date: _____________________ Mailing/Faxing Information: www.corporations.utah.gov/contactus.html Division's Website: www.corporations.utah.gov 01/14 American LegalNet, Inc. www.FormsWorkFlow.com