COVER LETTER 

TO: Amendment Section 
    Division of Corporations 

SUBJECT:  
Name of Corporation 

DOCUMENT NUMBER: 

The enclosed Statement of Change of Registered Office/Agent and fee are submitted for filing. 

Please return all correspondence concerning this matter to the following: 

Name of Contact Person 

Firm/Company 

Address 

City/State and Zip Code 

E-mail address: (to be used for future annual report notification)

For further information concerning this matter, please call: 

                                     at (                                 ) 
             Name of Contact Person        Area Code & Daytime Telephone Number 

Enclosed is a $35.00 check made payable to the Department of State. 

          Mailing Address:          Street Address: 
          Amendment Section         Amendment Section 
          Division of Corporations  Division of Corporations 
          P.O. Box 6327             The Centre of Tallahassee
          Tallahassee, FL 32314     2415 N. Monroe Street, Suite 810 
                                    Tallahassee, FL 32303 

CR2E045 (04/13) 

STATEMENT OF CHANGE OF REGISTERED OFFICE OR REGISTERED AGENT OR BOTH 
FOR CORPORATIONS 

Pursuant to the provisions of sections 607.0502, 617.0502, 607.1508, or 617.1508, Florida Statutes, this 
statement of change is submitted for a corporation organized under the laws of the State of    
 in order to change its registered office or registered agent, or both, in the State of Florida. 

1. The name of the corporation:

2. The principal office address:

3. The mailing address (if different):

4. Date of incorporation/qualification:                    Document number: 

5. The name and street address of the current registered agent and registered office on file with the
Florida Department of State: (If resigned, enter resigned)

6. The name and street address of the new registered agent (if changed) and /or registered office
(if changed):

                                        P.O. Box  NOT acceptable 

The street address of its registered office and the street address of the business office of its registered agent, 
as changed will be identical. 
Such change was authorized by resolution duly adopted by its board of directors or by an officer so 
authorized by the board, or the corporation has been notified in writing of the change. 

   Signature of an officer or director                       Printed or typed name and title 
I hereby accept the appointment as registered agent and agree to act in this capacity.  
I further agree to comply with the provisions of all statutes relative to the proper and complete performance 
of my duties, and I am familiar with and accept the obligation of my position as registered agent.  Or, if this 
document is being filed merely to reflect a change in the registered office address, I hereby confirm that the 
corporation has been notified in writing of this change. 

Signature of Registered Agent                                          Date 

If signing on behalf of an entity: 

Typed or Printed Name 

                                       * * * FILING FEE: $35.00 * * *
                MAKE CHECKS PAYABLE TO FLORIDA  EPARTMENTD           OF  TATES  
MAIL TO  : DIVISION OF  ORPORATIONS C   , P.O.  OXB       6327,  ALLAHASSEE T  , FL     32314 
CR2E045 (04/13)