State of North Carolina Department of the Secretary of State NONPROFIT CORPORATION’S DESIGNATION OF PRINCIPAL OFFICE ADDRESS
Pursuant to §55A-16-23(a) of the General Statutes of North Carolina, the undersigned nonprofit corporation does hereby submit the following for the purpose of designating its principal office address. 1. 2. 3. 4. The name of the corporation is: _________________________________________________________________________ (Check only if applicable.)_____The street address of the principal office is not currently on file with the Secretary of State. (Check only if applicable.)_____The mailing address of the principal office is not currently on file with the Secretary of State. The street address and county of the designated principal office of the corporation is: Number and Street: __________________________________________________________________________________ City, State, Zip Code: _________________________________________________County: ________________________ 5. The mailing address if different from the street address of the designated principal office is: __________________________________________________________________________________________________
This designation will be effective upon filing, unless a later date and/or time is specified: ________________________________ __________________________________________ Name of Corporation __________________________________________ Signature __________________________________________ Type or Print Name and Title
NOTES: 1. Filing fee is $5. This designation and one exact or conformed copy of it must be filed with the Secretary of State. (Revised January 2000) CORPORATIONS DIVISION (Form N-11) RALEIGH, NC 27626-0622
P.O. BOX 29622