Nonprofit Corporation's Statement of Change of Principal Office

State+of+North+Carolina+Department+of+the+Secretary+of+State+NONPROFIT+CORPORATION%e2%80%99S+STATEMENT+OF+CHANGE+OF+PRINCIPAL+OFFICE%0d%0aPursuant+to+%c2%a755A-16-23(b)+of+the+General+Statutes+of+North+Carolina%2c+the+undersigned+nonprofit+corporation+does+hereby+submit+the+following+for+the+purpose+of+changing+its+principal+office+address+currently+on+file+with+the+Secretary+of+State.+INFORMATION+CURRENTLY+ON+FILE+The+name+of+the+corporation+is%3a________________________________________________________________________+The+street+address+and+county+of+the+principal+office+of+the+corporation+currently+on+file+is%3a+Number+and+Street%3a+_________________________________________________________________________________+City%2c+State%2c+Zip+Code%3a+___________________________________________________________County%3a______________+The+mailing+address+if+different+from+the+street+address+of+the+principal+office+currently+on+file+is%3a+_________________________________________________________________________________________________+NEW+INFORMATION+1.+The+street+address+and+county+of+the+new+principal+office+of+the+corporation+is%3a+Number+and+Street%3a+____________________________________________________________________________+City%2c+State%2c+Zip+Code%3a+_______________________________________________________County%3a+____________+2.+3.+The+mailing+address+if+different+from+the+street+address+of+the+new+principal+office+is%3a+____________________________________________________________________________________________+This+statement+will+be+effective+upon+filing%2c+unless+a+later+date+and%2for+time+is+specified%3a+_____________________%0d%0a%0d%0aThis+is+the______day+of_________________%2c+20_____.+__________________________________________+Name+of+Corporation+__________________________________________+Signature+__________________________________________+Type+or+Print+Name+and+Title%0d%0a%0d%0aNOTES%3a+1.+Filing+fee+is+%245.+This+statement+and+one+exact+or+conformed+copy+of+it+must+be+filed+with+the+Secretary+of+State.%0d%0a%0d%0aRevised+January+2000+CORPORATIONS+DIVISION+0622%0d%0a%0d%0aP.+O.+BOX+29622%0d%0a%0d%0aForm+N-12+RALEIGH%2c+NC+27626-%0d%0a%0d%0a%0cInstructions+for+Filing+NONPROFIT+CORPORATION%e2%80%99S+STATEMENT+OF+CHANGE+OF+PRINCIPAL+OFFICE%0d%0aUnder+%e2%80%9cInformation+Currently+On+File%e2%80%9d+section%2c+enter+the+name+of+the+corporation+and+the+address+of+the+principal+office+as+they+currently+appear+on+the+records+of+the+Secretary+of+State.+Under+%e2%80%9cNew+Information%e2%80%9d+section%3a+Item+1+Item+2+Item+3+Enter+the+complete+street+address+and+county+of+the+new+principal+office+of+the+corporation.+Enter+the+complete+mailing+address+only+if+it+is+different+from+the+street+address+shown+in+Item+1.+The+document+will+be+effective+on+the+date+and+at+the+time+of+filing%2c+unless+a+delayed+date+and%2for+time+is+specified.+If+a+delayed+effective+date+and+time+is+specified%2c+the+document+will+be+effective+on+that+date+and+time.+A+delayed+effective+date+may+be+specified+up+to+and+including+the+90th+day+after+the+day+of+filing.+If+a+delayed+effective+date+is+specified+without+a+time%2c+the+document+will+be+effective+at+11%3a59%3a59+p.m.%0d%0a%0d%0aDate+and+Execution+Enter+the+date+the+document+was+executed.+In+the+blanks+provided+enter%3a+%e2%80%a2+The+name+of+the+corporation+executing+the+statement.+%e2%80%a2+The+signature+of+the+representative+of+the+corporation+(may+be+a+chairman+or+presiding+officer+of+the+board+of+directors+or+any+officer+of+the+corporation).+%e2%80%a2+The+name+and+title+of+the+above-signed+representative.%0d%0a%0d%0aRevised+January+2000+CORPORATIONS+DIVISION+0622%0d%0a%0d%0aP.+O.+BOX+29622%0d%0a%0d%0aForm+N-12+RALEIGH%2c+NC+27626-%0d%0a%0d%0a%0c