C-104G Rev. 7/1/02
New Jersey Division of Revenue
CERTIFICATE of CHANGE of REGISTERED OFFICE
&/or REGISTERED AGENT
(For Use by Domestic and Foreign, Profit and Non-profit Corporations)
CORPORATION NAME:
STATE OF ORIGINAL INCORPORATION:
IMPORTANT - INCLUDE INFORMATION ON BOTH THE PRIOR AND NEW AGENT
PRIOR AGENT NAME: NEW AGENT NAME:
PRIOR AGENT STREET ADDRESS NEW AGENT STREET ADDRESS
CITY STATE ZIP CITY STATE ZIP
NJ
The corporation states that the address of its new registered office and the address of its new registered agent are
identical. Further, the changes designated on this form were authorized by resolution duly adopted by its board of
directors or members.
By Title
(Signature of Officer) (Type)
Date:
NOTE - This form must be executed by the chairman of the board, the president, or the vice president of the
corporation.
FEES: Change of Agent Name-$25.00 MAIL TO: NJ Division of Revenue
Change of Agent Address-$25.00 PO Box 308
Change of Both-$25.00 Trenton, NJ 08646
Make checks payable to: TREASURER, STATE of NEW JERSEY (NO CASH PLEASE)
Rev 7/18/05
Instructions for Form C-104G
CERTIFICATE of CHANGE of REGISTERED OFFICE
and/or REGISTERED AGENT
(Titles 14A, 15A and 42:2A)
***Form C-104G can be used for ALL corporations and limited partnerships***
STATUTORY FEE: $25.00
The MANDATORY fields are:
Business Name
List the name as it appears on the records of the Treasurer.
Prior Agent Name
List the current agent name as it appears on the records of the Treasurer.
Prior Agent Office
List the current agent office as it appears on the records of the Treasurer.
New Agent Name
If you are changing the registered agent, list the new name; otherwise, leave this field
blank.
New Office
If you are changing the registered office, list the new address; otherwise, leave this
field blank. Provide a New Jersey street address. A PO box may be used only if the
street address is listed as well.
ATTESTATIONS
Add statements that indicate: 1) the address of its registered office and the address of
its registered agent will be identical after the change is filed; and 2) the change is made
pursuant to resolution of Board or membership. Form 104G provides these statements.
EXECUTION (DATE/SIGNATURE)
Have the chairman, president, vice-president, or current registered agent sign. Also, list
the date of execution (signature).
* * * * * * * * * *
These documents should be filed in duplicate. Non-profits should file in triplicate.
Make checks payable to: TREASURER, STATE OF NEW JERSEY. (No cash, please)
Mail to: NJ Division of Revenue, PO Box 308, Trenton, NJ 08646