Link to Doing Business As (DBA) Registration Information Change Form Addendum
          State of Utah             This form cannot be hand written.
          Department of Commerce                                                  Print Form             Instructions                 Clear Form
          Division of Corporations & Commercial Code 
              Doing Business As (DBA) Registration Information Change Form
 Non-Refundable Processing Fee: $13.00         Entity File Number: _________________________ 
 Entity Name: ___________________________________________________________________________________________ 
                        For each Yes button that you mark the question will appear below for you to fill out. 
 1). Do you want to Change the Business Purpose?                                                 Yes                               No 
 1). If Yes, what is the new Business Purpose? ___________________________________________________________________________ 
 2). Do you want to Change the Registered Agent or the Address of the Registered Agent?          Yes                               No 
 2). If Yes, who is the new Registered Agent, or the new Address of the Registered Agent? 
 _______________________________________________________________________________________________ 
                                                                         What is a commercial registered agent?
The  address must be listed if you have a non-commercial registered agent.  See instructions for further details.  
 Address of the Registered Agent: __________________________________________________________________ 
                                   Utah Street Address Required, PO Boxes can be listed after the Street Address 
 City ___________________________________________________________________________ State UT       Zip __________ 
 3). Do you want to Change the Principal Address of the Business Entity?                         Yes                               No 
 3). If Yes, what is the new Principal Address? 
 Address: ________________________________________________ City ___________________ State ______ Zip __________ 
 4). Do you want to Add individuals to the Business Entity?                                      Yes                               No 
 4). If Yes, who do you want to Add to the Business Entity and what Position will they hold? 
 Name: ____________________________________________               Position: ___________________________________________Select/Type the position here
 Address: ________________________________________________ City ___________________ State ______ Zip __________ 
 Name: ____________________________________________               Position: ___________________________________________Select/Type the position here
 Address: ________________________________________________ City ___________________ State ______ Zip __________ 
 5). Do you want to Remove individuals from the Business Entity?                                 Yes                               No 
 5). If Yes, who do you want to Remove from the Business Entity and what Position do they hold? 
 Name: _________________________________________                  Position: ___________________________________________Select/Type the position here
 Name: _________________________________________                  Position: ___________________________________________Select/Type the position here
 6). Do you want to Change the Address of the Business Entity’s Principal(s)?                    Yes                               No 
 6). If Yes, who is the Principal(s) whose Address you wish to Change? 
 Name: ____________________________________________               Position: ___________________________________________Select/Type the position here
 Address: ________________________________________________ City ___________________ State ______ Zip __________ 
 Name: ____________________________________________               Position: ___________________________________________Select/Type the position here 
                                                                                                                                                               
 Address: ________________________________________________ City ___________________ State ______ Zip__________ 
                                                                                                                                                        
 Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record.  For confidentiality purposes, you may use 
 the business entity physical address rather than the residential or private address of any individual affiliated with the entity. 

 Under penalties of perjury and as an authorized authority, I declare that this statement of change(s), has been examined by me and is, to the best of 
 my knowledge and belief, true, correct and complete.  
 Name/Title: ___________________________________ Signature: _________________________________ Date: ____________________ 

 08/23