Nonprofit Corporations Statement Of Change Of Principal Office {N-12}

BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised August 2017) Form N-12 State of North Carolina Department of the Secretary of State NONPROFIT CORPORATION222S STATEMENT OF CHANGE OF PRINCIPAL OFFICE Pursuant to 24755A-16-23(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 theday of, 20. Name of Corporation Signature Type or Print Name and Title NOTES: 1. Filing fee is $5. This statement must be filed with the Secretary of State. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised August 2017) Form N-12 Instructions for Filing NONPROFIT CORPORATION222S STATEMENT OF CHANGE OF PRINCIPAL OFFICE Under 223Information Currently On File224 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 223New Information224 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. American LegalNet, Inc. www.FormsWorkFlow.com