Fillable STATE OF NORTH CAROLINA STATEMENT OF CHANGE OF (North Carolina Secretary of State)

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STATE OF NORTH CAROLINA STATEMENT OF CHANGE OF (North Carolina Secretary of State)

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BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
Revised July 2017 Form BE-06
INFORMATION CURRENTLY ON FILE
STATE OF NORTH CAROLINA
DEPARTMENT OF THE SECRETARY OF STATE
STATEMENT OF CHANGE OF REGISTERED
OFFICE AND/OR REGISTERED AGENT
Pursuant to §55D-31 of the General Statutes of North Carolina, the undersigned entity submits the following for the purpose of
changing its registered office and/or registered agent in the State of North Carolina.
The name of the entity is: _________________________________________________________________________________
The street address and county of the entity’s registered office currently on file is:
Number and Street: __________________________________________________________________________________________
City: _______________________ State: NC Zip Code: ____________________ County: __________________________
The mailing address if different from the street address of the registered office currently on file is:
Number and Street: __________________________________________________________________________________________
City: _______________________ State: NC Zip Code: ____________________ County: __________________________
The name of the current registered agent is: ______________________________________________________________________
1. The street address and county of the new registered office of the entity is:
(complete this item only if the address of the registered office is being changed)
Number and Street: _______________________________________________________________________________________
City: _______________________ State: NC Zip Code: ____________________ County: __________________________
2. The mailing address if different from the street address of the new registered office is:
(complete this item only if the address of the registered office is being changed)
Number and Street: _______________________________________________________________________________________
City: _______________________ State: NC Zip Code: ____________________ County: __________________________
3. The name of the new registered agent and the new agent’s consent to appointment appears below:
(complete this item only if the name of the registered agent is being changed)
______________________________________________ __________________________________________________
Type or Print Name of New Agent * Signature & Title
4. The address of the entity’s registered office and the address of the business office of its registered agent, as changed,
will be identical.
5. This statement will be effective upon filing, unless a date and/or time is specified: _____________________________________
This is the _____day of _______________, 20____.
_________________________________________
Entity Name
__________________________________________
Signature
__________________________________________
Notes: Filing fee is $5.00. This document must be filed with the Secretary of State. Type or Print Name and Title
* Instead of signing here, the new registered agent may sign a separate written consent to the appointment, which must be attached to this statement.
NEW INFORMATION
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BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
Revised July 2017 Form BE-06
STATEMENT OF CHANGE OF REGISTERED OFFICE
AND/OR REGISTERED AGENT
Instructions For Filing
(Form BE-06)
Under “Information Currently On File” section:
Enter the name of the entity and the name and address of the registered agent and registered office as they
currently appear on the records of the Secretary of State.
Under “New Information” section:
Item 1 Enter the complete street address and county of the new registered office.
Item 2 Enter the complete mailing address only if it is different from the street address shown in Item 1.
Item 3 Enter the new registered agent’s name, signature, and title (if the new registered agent is an
entity). The registered agent must be a North Carolina resident, an existing domestic business
corporation, nonprofit corporation, limited liability company, or a foreign business corporation,
nonprofit corporation, or limited liability company authorized to do business or conduct affairs in
North Carolina (other than your own entity).
Item 4 See form.
Item 5 The document will be effective on the date and at the time of filing, unless a delayed date or an
effective time (on the day of filing) is specified. If a delayed effective date is specified without a
time, the document will be effective at 11:59:59 p.m. on the day specified. If a delayed effective
date is specified with a time, the document will be effective on the day and at the time specified.
A delayed effective date may be specified up to and including the 90th day after the day of filing.
Date and Execution
Enter the date the document was executed.
In the blanks provided enter:
• The name of the entity.
• An officer, manager, or general partner of the entity must sign.
• The name and the title of the above-signed representative.
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STATE OF NORTH CAROLINA STATEMENT OF CHANGE OF (North Carolina Secretary of State)

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Completed 1 February 2022

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