Fill and Sign the Nonrefundable Filing Fee 25 Form

FORM X-7 7/2012 STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS Business Registration Division 335 Merchant Street Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810 Phone No. (808)586-2727 STATEMENT OF CHANGE OF REGISTERED AGENT BY ENTITY (Section 425R-7 Hawaii Revised Statutes) PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK The undersigned certify as follows: 1. Specify represented entity type, please check one: 2. The name and state/country of incorporation/formation or organization of the represented entity is: (Type/Print Entity Name) 3. a. Name of its current registered agent: b. Street address of agent's current office in this State: 4. Name of the entity's new registered agent after the change is: (Type/Print Name of Agent) (State or Country, if Agent is an Entity) 5. Street address (including number, street, city, state, and zip code) of its registered agent's office in this State after the change is: 6. The appointment of a registered agent in this statement is an affirmation by the represented entity that the new agent has consented to serve as such. I/we certify under the penalties of Section 414-20, 414D-12, 425-13, 425-172, 425E-208 and 428-1302, Hawaii Revised Statutes, as applicable, that I/we have read the above statements, I/we are authorized to make this change, and that the above statements are true and correct. (Type/Print Name & Title) (Signature of Officer) (Signature of Officer) SEE INSTRUCTIONS ON REVERSE SIDE. Nonrefundable Filing Fee: $25.00 *X7* Represented Entity (that wishes to change its registered agent) Profit Corporation Nonprofit Corporation General Partnership Limited Liability Partnership Limited Partnership Limited Liability Limited Partnership Limited Liability Company (State or Country) Current Agent Information Signed this day of , WWW.BUSINESSREGISTRATIONS.COM New Agent Appointment (Type/Print Name & Title) Clear Info FORM X-7 7/2012 Instructions : Statement must be typewritten or printed in black ink, and must be legible. All signatures must be in black ink. Submit original statement together with the appropriate fee(s). Execution: For corporations , document must be signed by at least one officer of the corporation. For general partnerships , document must be signed by at least one general partner. For limited liability partnerships , document must be signed and certified by at least one partner. For limited partnerships , document must be signed by at least one general partner. For limited liability limited partnerships , document must be signed by at least one general partner. For limited liability company , document must be signed and certified by at least one manager of a manager-managed company or by at least one member of a member-managed company. Line 1. Check the appropriate box that applies to the represented entity. Line 2. State the full name and the state/country of incorporation/formation or organization of the represented entity. Line 3. a. State the name of the current registered agent, before the change. b. State the street address of the agent's current office in Hawaii, before the change Line 4. State the name of the new registered agent in the State of Hawaii. If there has been no change, state NO CHANGE. The agent must be an individual resident of Hawaii, a domestic entity, or a foreign entity authorized to transact business or conduct affairs in the State of Hawaii. If agent is an entity, state the state or country of incorporation/formation or organization of the agent. Line 5. State the new address of the new registered agent's office in the State of Hawaii. Give the number, street, city, state and zip code. If there has been no change in the address, state NO CHANGE. Filing Fees: Filing fee ($25) is not refundable. (200 or less affected entities, the filing fee is $25 each. 201 or more affected entities, the filing fee is $1 each.) Make checks payable to DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS. Dishonored Check Fee ($25). For any questions call (808) 586-2727. Neighbor islands may call the following numbers followed by 6-2727 and the # sign: Kauai 274-3141; Maui 984-2400; Hawaii 974-4000, Lanai & Molokai 1-800-468-4644 (toll free). Fax: (808) 586-2733 Email Address: breg@dcca.hawaii.gov NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE DIVISION SECRETARY, BUSINESS REGISTRATION DIVISION, DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST. ALL BUSINESS REGISTRATION FILINGS ARE OPEN TO PUBLIC INSPECTION. (SECTION 92F-11, HRS)