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FORM BCA 5.10/5.20 (rev. Dec. 2003) 
STATEMENT OF CHANGE OF 
REGISTERED AGENT AND/OR 
REGISTERED OFFICE 
Business Corporation Act 
 
Secretary of State 
Department of Business Services 
501 S. Second St., Rm. 350 
Springfield, IL  62756 
217-782-7808 
ilsos.gov 
 
Remit payment in the form of a 
check or money order payable  
to Secretary of State. 
                  
Submit in duplicate ___________________  File #_____________________________    Filing Fee: $25    Approved: _____________ 
 
1.   Corporate name:  _______________________________________________________________________________ 

2.   State or country of incorporation: ___________________________________________________________________ 

3.   Name and address of Registered Agent and registered office as they appear on the records of the Office of the Secretary 
      of State (before change): 

      Registered Agent: _______________________________________________________________________________ 
                                                             First Name                                             Middle Name                                                   Last Name 

      Registered office: _______________________________________________________________________________ 
                                                                Number                                                     Street                                 Suite # (P.O. Box alone is unacceptable) 
                                                                                           IL
                                                                      ` 
                                                                   City                                                          ZIP                                                              County 

4.   Name and address of Registered Agent and registered office shall be (after all changes herein reported): 

      Registered Agent: _______________________________________________________________________________ 
                                                             First Name                                             Middle Name                                                   Last Name 

      Registered office: _______________________________________________________________________________ 
                                                                Number                                                     Street                                 Suite # (P.O. Box alone is unacceptable) 
      Registered Office            _______________________________________________________________________________IL
                                                                   City                                                          ZIP                                                              County 

5.   The address of the registered office and the address of the business office of the registered agent, as changed, will be identical. 

6.   The above change was authorized by: (“X” one box only) 
      a.      q Resolution duly adopted by the board of directors.          (See Note 4 on reverse.) 
      b.      q Action of the registered agent. (See Note 5 on reverse.) 
 
7. The undersigned under penalties of perjury, affirms that the facts stated herein are true and correct. 
 
  Dated: _______________________________ ,  _____    ________________________________________________  
                                   Month             Day                                 Year                                                Exact name of corporation 
                 ______________________________________ 
             Signature of Registered Agent of record or authorized officer 
                 ______________________________________ 
                                 Name and title (type or print) 
_______________________________________________________  
If applicant is signing for a company or other entity, state name of company or entity. 
 
                                   Printed by authority of the State of Illinois. January 2023 — 1 — C 135.26

                                                         NOTES 

1. The registered office may, but need not be, the same as the principal office of the corporation; however, the registered 
 office and the office address of the registered agent must be the same. 

2. The registered office must include a street or road address (P.O. Box alone is unacceptable). 

3. The registered agent and registered office must use an Illinois address. 

4. A corporation cannot act as its own registered agent. 

5. Any change of registered agent must be by resolution adopted by the board of directors. This statement must be signed 
 by a duly authorized officer. 

6. The registered agent may report a change of the registered office of the corporation for which he/she is a registered 
 agent. When the agent reports such a change, this statement must be signed by the registered agent. If a corporation is 
 acting as the registered agent, a duly authorized officer of such corporation must sign this statement.