1. Limited Liability Company name: ____________________________________________________________________
2. Name and address of registered agent and registered office as they now appear on the records of the Office of the Secre-
tary of State (before change):
Registered agent: ________________________________________________________________________________
First Name Middle Name Last Name
Registered office: ________________________________________________________________________________
Number Street Suite No. (P.O. Box alone is unacceptable)
Registered Office: ________________________________________________________________________________
City ZIP
3. Name and address of registered agent and registered office shall be (after change):
Registered agent: ________________________________________________________________________________
(See Notes) First Name Middle Name Last Name
Registered office: ________________________________________________________________________________
(See Notes) Number Street Suite No. (P.O. Box alone is unacceptable)
Registered Office: ________________________________________________________________________________
City ZIP
4. The address of the registered office and the address of the business office of the registered agent, as changed, will be
identical.
5. The above change was authorized by: (check one box only)
a.
n
the members or manager, having authority to change the registered agent, registered office address or both.
b.
n
the registered agent, who is changing only the registered office address.
6. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this statement of change of reg-
istered agent and/or registered office is to the best of my knowledge and belief, true, correct and complete.
Dated: _______________________________, ________________
Month/Day Year
________________________________________________________
Signature
________________________________________________________
Name and Title (type or print)
________________________________________________________
If applicant is signing for a company or other entity, state name of company or entity.
Form LLC-1.36/1.37
August 2018
Illinois
Limited Liability Company Act
Statement of Change of Registered
Agent and/or Registered Office
Printed by authority of the State of Illinois. October 2019 — 1 — LLC 36.8
SUBMIT IN DUPLICATE
Type or print clearly.
This space for use by Secretary of State.
Filing Fee: $25
Penalty (See Note 1 on page 2.):
Approved:
IL
IL
S
ecretary of State
Department of Business Services
Limited Liability Division
501 S. Second St., Rm. 351
Springfield, IL 62756
2
17-524-8008
www.cyberdriveillinois.com
Payment may be made by check
payable to Secretary of State. If check
is returned for any reason this filing
w
ill be void.
This space for use by Secretary of State.
F
ILE #
