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: $15.00                                       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 __________ 
Optional  Inclusion of Ownership Information:  This information is not required.   
Is this a female owned business?          Yes            No 
Is this a minority owned business?        Yes            No         If yes, please specify:Select/Type_____________________________________the race of the owner here

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: _________________________________Sign here after printing form Date: ____________________ 
Mailing/Faxing Information: www.corporations.utah.gov/contactus.html               Division's Website: www.corporations.utah.gov
 01/20