State of Utah                   This form cannot be hand written.         Link to Corporation Registration Information Change Form Addendum

         Department of Commerce                                                                   Print Form        Instructions             Clear Form
         Division of Corporations & Commercial Code 
         Corporation 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