Statement Of Change Of Mailing Address Of Surviving Entity {LP-10}

State of North Carolina Department of the Secretary of State STATEMENT OF CHANGE OF MAILING ADDRESS OF SURVIVING ENTITY* 1. Pursuant to N.C.Gen. Stat. 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 afterArticles of Merger or an Application for Certificate of Withdrawal by Reason of Merger, Consolidation or Conversion have been filed. This formshould not be used to change the registered office address. A Statement of Change of Registered Office and/or Registered Agent should be usedfor that purpose. (August 2000) (Form LP-10)CORPORATIONS DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622