DISCLAIMER: All documents filed with the Corporation Division become public records and will be available for
public inspection in either tangible or electronic form.
Mailing Address - Corporation Division, NH Dept. of State, 107 N Main St, Rm 204, Concord, NH 03301-4989
Physical Location - State House Annex, 3rd Floor, Rm 317, 25 Capitol St, Concord, NH
Form 10 (9/2015)
State of New Hampshire
Filing fee: $15.00 Form 10
(Filing fee waived if submitted on RSA 293-A:5.02(a), RSA 293-A:15.08(a),
the Annual Report, filing period RSA 304-C:36 II, RSA 304-C:177 V,
January 1
st
through April 1
st
.*) or RSA 304-A:49 II
Use black print or type.
STATEMENT OF CHANGE OF REGISTERED OFFICE
OR REGISTERED AGENT, OR BOTH
PURSUANT TO THE PROVISIONS of the New Hampshire Revised Statutes Annotated, the undersigned
business, organized under the laws of submits the following statement for
the purpose of changing the registered office or the registered agent, or both, in the state of New
Hampshire. If submitted by the Registered Agent, the listed business has been notified in writing of the
change in registered office.
FIRST: The name of the business is:
.
SECOND: The name of its registered agent is recorded as:
.
THIRD: The address of its registered office is recorded as:
.
(no. & street) (city/town) (state) (zip code)
FOURTH: The name of its new registered agent (if applicable) is (Note 1):
.
FIFTH: The address of its new registered office is (Note 1):
.
(no. & street) (city/town) (state) (zip code)
SIXTH: The street address, town/city of its registered office and the address of the business office of its
registered agent, as changed, will be identical.
SEVENTH: Pursuant to the provisions of RSA 293-A:5.02(a), RSA 293-A:15.08(a), RSA 304-C:36 II,
RSA 304-C:177 V or RSA 304-A:49 II, this document must be executed by an officer or director, a
manager or member, a partner or agent.
(Signature)
(Print or type name)
(Title)
Date signed:
