Vermont Business Registration

CHANGE OF REGISTERED AGENT OR AGENT ADDRESS

Vermont Secretary of State

of a Business or Nonprofit Entity, Trade Name, or Telemarketer

PLEASE REVIEW INSTRUCTIONS PAGE BEFORE BEGINNING.

THIS DOCUMENT MUST BE TYPEWRITTEN OR PRINTED (11A V.S.A. § 1.20)

1. BUSINESS NAME: REQUIRED

2. BUSINESS REGISTRATION TYPE OF RECORD: REQUIRED - SELECT ONLY ONE (1) OF THE FOLLOWING

Profit Corporation (11A V.S.A. § 4.02)

Nonprofit Corporation (11B V.S.A. § 4.02)

Mutual Benefit Enterprise (MBE) (11C V.S.A. § 118)

Limited Liability Company (LLC, PLC, or L3C) (11 V.S.A. § 3006)

Partnership (General, LLP, or LP) (11 V.S.A. § 3310(13), 11 V.S.A. § 3404)

Trade Name (11 V.S.A. § 1621a)

Telemarketer (9 V.S.A. § 2464b)

3. CURRENT REGISTERED AGENT INFORMATION OF RECORD: REQUIRED - AS CURRENTLY ON RECORD WITH THE VT SECRETARY OF STATE

a. Name:

b. Physical Address:

City/Town: State: ZIP Code:

c. Mailing Address:

City/Town: State: ZIP Code:

4. NEW REGISTERED AGENT INFORMATION: REQUIRED – MUST SELECT AND FILL IN AT LEAST ONE (1) OF THE FOLLOWING

a. NEW REGISTERED AGENT: IF SELECTED

Name:

b. NEW PHYSICAL ADDRESS: IF SELECTED

Physical Address:

City/Town: State: Zip Code:

c. NEW MAILING ADDRESS: IF SELECTED

Mailing Address:

City/Town: State: Zip Code:

d. NEW EMAIL: IF SELECTED

CERTIFICATION OF CHANGE: REQUIRED

a. I hereby certify, under penalty of law, that I am authorized to file this document, the above information is accurate as of the filing date, and that this form is provided in duplicate, with a self-addressed stamped envelope and a check or money order, payable to the VT SOS, in the amount of $25.00.

b. I hereby confirm my appointment as Registered Agent for this Business Entity or Trade Name. IF LINE 4a. SELECTED AS A CHANGE.

PLEASE REVIEW INSTRUCTIONS ON REVERSE BEFORE FILING.

SUBMISSION INSTRUCTIONS

1. This registration must be filed in duplicate, i.e. ONE (1) ORIGINAL + ONE (1) COPY -or- TWO (2) ORIGINALS, with a self addressed stamped envelope and a check or money order, payable to “VT SOS” in the amount of $25.00.

NOTE: Nonprofit Change of Agent or Office Fee is also $25.00 as of 7/1/2013.

2. Changes of Registered Agent may only be accepted by Mail or In-person at:

Vermont Secretary of State
Corporations Division
128 State Street
Montpelier, VT 05633-1104

Note: Changes of Registered Agent or Office cannot be accepted by Phone, Fax, or E-mail.

3. Payment Options: Check or Money Order made payable to “VT SOS”

a. Payments cannot be accepted by Phone, Fax or E-mail.

b. Credit cards cannot be accepted for reinstatement applications.

c. Cash should not be sent by Mail.

4. Evidence of Filing will be returned the first business day following processing – also you may check our website for filing verification at:

https://www.vtsosonline.com/online/BusinessInquire/

a. Please, allow 3-5 business days, from the day this is received in our office, for processing.

b. Please, allow 2-4 weeks, following processing, for the Website information to be updated.

***THIS FILING IS NOW AVAILABLE ONLINE***

• THIS FORM CANNOT be accepted by Phone, Fax, or E-mail; however, this filing is now available online:

- If you wish to submit this filing electronically, DO NOT fill out THIS FORM, please file online at https://www.vtsosonline.com/online/Account.

• Payment for THIS FORM also CANNOT be accepted by credit card or e-check (ACH); however, payment by credit card or e-check (ACH) is available by filing online:

- If you wish to submit payment by credit card or e-check (ACH), DO NOT fill out THIS FORM, please file online at https://www.vtsosonline.com/online/Account.

• Online filing normally takes 1 business day or less.

FORM INSTRUCTIONS

Line 1. REQUIRED Each Business Entity must continuously maintain in this state a registered agent, who may be an individual or an active registered business entity (no trade name (DBA) registrations) with a physical business address in the state of Vermont.

Line 2. REQUIRED Must select the business type on record for the business listed on Line 1.

Line 3. REQUIRED Registered Agent information exactly as on record with the Vermont Secretary of State.

Line 4. REQUIRED Must select and fill in AT LEAST ONE (1) piece of registered agent information to change.

Certification. REQUIRED

a. If the Registered Agent is changing, both of the following must sign:

(1) An authorized representative of the business filing this form

(2) The new registered agent confirming appointment or a principal of the corporate or company Registered Agent

NOTE: A separate written letter of confirmation signed by the Registered Agent (or authorized representative) will be accepted in place of the New Agent’s signature on this form.

b. If only the office, mailing address, or email of the Registered Agent is being changed: only the signature of an Authorized Representative of either the Business Entity or of the current Registered Agent will sign as certifying official.

c. Authorized representative(s) by business structure:

(1) PROFT CORPORATION, NONPROFIT CORPORATION, MBE, LLC/PLC/L3C, LP, or Trade Name (DBA) – One principal currently on record with the Vermont Secretary of State

(2) GENERAL OR LIMITED LIABILITY PARTNERSHIP – Two (2) Partners currently on record with the Vermont Secretary of State. (11 V.S.A. § 3275(A))