Statement of Designation or Change of Registered Agent and/or Registered Office

State of Utah – Department of Commerce, Division of Corporations & Commercial Code
(Utah Code Ann. § 16-17-203)

[// GUIDANCE:
1. Use this template for any domestic or foreign entity registered in Utah—corporation, LLC, LP, LLP, business trust, etc.—to (a) designate its initial registered agent/office or (b) change an existing designation.
2. File the executed Statement with the Utah Division of Corporations & Commercial Code (“Division”) together with the required filing fee (currently $15; verify before filing).
3. Online filing is fastest, but you may also file by mail or in person (160 E 300 S, 2nd Fl., Salt Lake City, UT 84114-6705).
4. A Utah registered agent must be either (i) an individual resident of Utah or (ii) a business entity authorized to transact business in Utah. The registered office must be the agent’s Utah street address (no P.O. Boxes).
5. The agent must consent in writing—either by signing this form or by delivering a separate written consent you will attach to the filing.]

Effective Date (select one):
☐ Upon processing by the Division
☐ Delayed effective date (no more than 90 days after filing): _______________

Utah Entity Number: [UTAH ENTITY #]

I. Recitals

WHEREAS, [LEGAL ENTITY NAME], a [DOMESTIC / FOREIGN] [ENTITY TYPE] organized under the laws of [STATE/COUNTRY OF ORGANIZATION] (the “Entity”), is required by Utah Code Ann. §§ 16-17-201 et seq. to maintain a registered agent and registered office in the State of Utah; and

WHEREAS, the Entity desires to (check one):
☐ designate its initial registered agent/office; OR
☐ change its registered agent and/or registered office now on file with the Division;

NOW, THEREFORE, the Entity hereby submits this Statement of Designation or Change of Registered Agent and/or Registered Office (the “Statement”).

II. Definitions

“Division” – Utah Department of Commerce, Division of Corporations & Commercial Code.
“Registered Agent” – Individual or business entity appointed under Utah Code Ann. § 16-17-201 to receive service of process, notices, and demands for the Entity.
“Registered Office” – The Utah street address of the Registered Agent’s business office, identical to the address listed with the Division.

III. Statement & Designation

1. Entity Information
   a. Exact legal name: [LEGAL ENTITY NAME]
   b. Jurisdiction of formation: [STATE/COUNTRY]
   c. Business mailing address (optional): [MAILING ADDRESS]

2. Current Registered Agent/Office (complete only if changing)
   a. Name of current registered agent: [CURRENT AGENT NAME]
   b. Street address of current registered office: [CURRENT STREET ADDR., CITY, UT ZIP]

3. Appointment of New Registered Agent & Registered Office
   a. Name of new registered agent: [NEW AGENT NAME]
   • If individual: Utah residence address: [STREET, CITY, UT ZIP]
   • If entity: Utah registration number: [UTAH REG. #]
   b. Street address of new registered office (must be identical to agent’s Utah business office; no P.O. Boxes):
   [STREET, SUITE, CITY, UT ZIP]
   c. Mailing address of agent (if different): [MAILING ADDRESS]

[// GUIDANCE: Verify that the street address in § 3(b) is physically located in Utah and is not a P.O. Box to satisfy Utah Code Ann. § 16-17-204(1).]

4. Consent of Registered Agent
   The undersigned Registered Agent hereby (i) accepts the appointment, (ii) certifies that the address in § 3(b) is the agent’s business office, and (iii) confirms compliance with Utah Code Ann. § 16-17-201.

Registered Agent Signature: ______________________________________
Printed Name & Title: [NAME / TITLE]
Date: __________________

5. Authorization & Certification by Entity
   I declare under penalty of perjury that I am authorized to sign this Statement for the Entity and that the information provided herein is true, correct, and complete.

Entity Name: [LEGAL ENTITY NAME]

By: ______________________________________
Printed Name: [SIGNATORY NAME]
Title: [AUTHORIZED TITLE – e.g., President, Manager]
Date: __________________

IV. Optional Best-Practice Provisions (do not file with Division unless you want them on public record)

1. Successor Agent. If the Registered Agent resigns under Utah Code Ann. § 16-17-204, the Entity shall appoint a successor agent within 30 days after receiving notice of resignation.
2. Amendment. This Statement may be amended by filing a subsequent statement of change that complies with Utah Code Ann. § 16-17-203.
3. Severability. If any provision of this Statement is held invalid, the remaining provisions shall remain in effect.

V. Filing Checklist (retain for internal use)

☐ Signed by authorized Entity representative
☐ Signed (or separately consented) by Registered Agent
☐ Filing fee enclosed / paid online
☐ All street addresses located in Utah, no P.O. Boxes
☐ Copy saved to Entity’s minute book

[END OF TEMPLATE]