Fill and Sign the Registration Form Wyoming Secretary of State

For Office Use Only Wyoming Secretary of State 2020 Carey Avenue, Suite 700 Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: Business@wyo.gov RA-RO ChangeByEntity – Revised August 2017 Change of an Entity’s Registered Agent and Office This form is used ONLY to change the registered agen t from one person/company to a different person/company. 1. Name of the business entity: 2. Name of former registered agent and physical address of former registered office: ( The former registered agent information provided must match exactly with the Secretary of State’s records.) Former Registered Agent: Former Registered Office Address: 3. Name of new registered agent and physical Wyoming address of new registered office: New Registered Agent: New Registered Physical Office Address (must be located in Wyoming): New Registered Agent’s Mailing Address: (To include a PO Box in the address it must have the same zip code as the registered office.) For consistency the Secretary of State’s office will only keep one version of the agent’s name and address on file. RA-RO ChangeByEntity – Revised August 2017 4. I hereby certify that the new registered office and the registered agent co mply with the requirements of W.S. 17-28- 101 through W.S. 17-28-111. 5. The mailing address of my business should be changed to reflect the new registered office address. Yes No 6. The principal address of my busin ess should be changed to reflect the ne w registered office address. Yes No 7. Once completed the physical address of the registered office and business o ffice of the registered agent will be identical. Signature: ______________________________________________ Date: (Shall be execut ed by an authorized indivi dual) (mm/dd/yyyy) Print Name: Contact Person: Title: Daytime Phone: E m ail: (Email provided will receive filing evidence.) *May list multiple email ad dresses Checklist No Filing Fee This form must be accompanied by a written consent to appoin tment executed by the new registered agent. Please submit one originally signed document. Please review form prior to submitting to the S ecretary of State to ensure all areas have been completed to avoid a delay in the processing of your documents. Wyoming Secretary of State 2020 Carey Avenue, Suite 700 Cheyenne, WY 82002 -0020 Ph. 307. 777.7311 Fax 307. 777.5339 Email: Business@wyo.gov RAConsent – Revised October 2015 Consent to Appointment by Registered Agent I, , registered office located at (name of registered agent) voluntarily consent to serve * (registered office physical address, city, state & zip) a s the registered agent for (name of business entity) I h ereby certify that I am in compliance with the requirements of W.S. 17-28-101 through W .S. 17-28-111. Signature:__________________________________________ Date: (Shall be executed by the registered agent .) (mm/dd/yyyy) Print Name: Daytime Phone: Title: Email: Registered Agent Mailing Address (if different than above) : * If this is a current registered agent changing their registered address on file , complete the following: Previous Registered Office (s): I hereby certify that: • After the changes are made, the street address of my registered office and business office will be identical. • This change affects every entity served by me and I have notified each entity of the registered office change. • I certify t hat the above information is correct and I am in compliance with the requiremen ts of W.S. 17-28 -101 through W.S. 17 -28 -111. Signature: __________________________________________ Date: (Shall be executed by the registered agent .) (mm/dd/yyyy)