FILING FEE: $30.00
Revised 01/10/2019
Neb. Rev. Stat. §21-234
Robert B. Evnen, Secretary of State
P.O. Box 94608
Lincoln, NE 68509
The following corporation, pursuant to the laws of the state of Nebraska, does hereby wish to change its
Registered Agent and/or Registered Office.
Name of Corporation_________________________________________________________________
Registered Agent: _________________________________________________________________
Registered Office: __________________________________________________NE_____________
Street Address and Post Office Box (if any) City Zip
Registered Agent: __________________________________________________________________
Registered Office*: ___________________________________________________NE____________
Street Address and Post Office Box (if any) City Zip
* The street address of the registered office and the street address of the registered agent must be
DATED___________________________ __________________________________________
Printed Name/Title
NOTE: Every filing must be signed by the chairperson of the board of directors, the president, or one of the officers of the
corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing shall be signed by
an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed fiduciary, the filing shall be
signed by that fiduciary. Signing a false document which is filed or attempted to be filed with the Secretary of State is a
Class I Misdemeanor, subject to up to one year imprisonment or a $1000 fine, or both.
Registered Agent: Please check A (current agent) or B (new agent) below and sign
____ A. I hereby state that the above named corporation has been notified of the change in
address of my registered office.
____B. I hereby consent to act as registered agent for the above named corporation.
Signature of Registered Agent