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DOMESTIC CHANGE OF
REGISTERED AGENT and/or OFFICE
NON-PROFIT CORPORATIONS
Submit in Duplicate
Robert B. Evnen, Secretary of State
P.O. Box 94608
Lincoln, NE 68509
www.sos.ne.gov
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__________________________________________________________
Previous:
Registered Agent: __________________________________________________________
Registered Office: ________________________________________NE________________
Street Address and Post Office Box (if any) City Zip
New:
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
identical.
DATED___________________________ ___________________________________
Signature
Printed Name/Title
NOTE: Every filing must be signed by the presiding officer 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
FILING FEE: $10.00
Revised 01/10/2019
Neb. Rev. Stat. 21-1935
