Fillable New Jersey Division of Revenue Certificate of Change (The State of New Jersey)

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New Jersey Division of Revenue Certificate of Change (The State of New Jersey)

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L-122 (4/94)
New Jersey Division of Revenue
Certificate of Change - Registered Name or Address, or Both
( For Use by a Limited Liability Company)
This form may be used by domestic and foreign Limited Liability Companies to change an agent name or address or
both. If a P.O. box is used for registered address, the street address must be included. Return this form with a
$25.00 check made out to: Treasurer, State of New Jersey. Write the LLC number on the top left of your check.
LLC Name and Number:
State of Original Filing:
IMPORTANT - INCLUDE INFORMATION ON BOTH THE PRIOR & NEW AGENT
Prior Agent:
Name
Street Address
City State Zip
New Agent:
Name
Street.Address
City State Zip
______________________________________ ______________
Signature of Registered Agent Date
NJ Division of Revenue, PO Box 308, Trenton, NJ 08646
Rev 7/18/05
Instructions for Form L-122
CERTIFICATE OF CHANGE OF REGISTERED AGENT/ADDRESS OR BOTH,
For LIMITED LIABILITY COMPANIES
(Title 42:2B)
STATUTORY FEE: $25
The MANDATORY fields are:
Business Name/Number
List the name and ten-digit business ID as they appear on the records of the State
Treasurer.
Prior Agent Name
List the current agent name as it appears on the records of the State Treasurer.
Prior Agent Office
List the current agent office as it appears on the records of the State 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.
EXECUTION (DATE/SIGNATURE)
Have an authorized representative or the 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
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New Jersey Division of Revenue Certificate of Change (The State of New Jersey)

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Completed 3 March 2021

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