"Statement of Change Changing the Jurisdiction - Sample" - Colorado

Statement of Change Changing the Jurisdiction - Sample is a legal document that was released by the Colorado Secretary of State - a government authority operating within Colorado.

Form Details:

  • Released on November 14, 2017;
  • The latest edition currently provided by the Colorado Secretary of State;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Colorado Secretary of State.

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Download "Statement of Change Changing the Jurisdiction - Sample" - Colorado

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Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Statement of Change Changing the Jurisdiction
filed pursuant to §7-90-305.5 and §7-90-804 of the Colorado Revised Statutes (C.R.S.)
1. For the entity, its ID number, entity name, and true name if applicable are
ID number
_________________________
(Colorado Secretary of State ID number)
Entity name
_____________________________________________________________________________________.
True name
_____________________________________________________________________________________.
2. The document number of the filed document being changed is
________________________________.
3. The jurisdiction under the law of which the entity is formed has changed.
4. The jurisdiction as changed is ___________________________________________________________.
5.
This document contains additional information as provided by law.
6.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant legal
consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document is/are _________________________.
(mm/dd/yyyy hour:minute am/pm)
Notice:
Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the
individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person
on whose behalf the individual is causing the document to be delivered for filing, taken in conformity with the
requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic statutes, and that the
individual in good faith believes the facts stated in the document are true and the document complies with the
requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the secretary of state,
whether or not such individual is named in the document as one who has caused it to be delivered.
CHANGE_JURIS
Page 1 of 2
Rev. 11/14/2017
Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Statement of Change Changing the Jurisdiction
filed pursuant to §7-90-305.5 and §7-90-804 of the Colorado Revised Statutes (C.R.S.)
1. For the entity, its ID number, entity name, and true name if applicable are
ID number
_________________________
(Colorado Secretary of State ID number)
Entity name
_____________________________________________________________________________________.
True name
_____________________________________________________________________________________.
2. The document number of the filed document being changed is
________________________________.
3. The jurisdiction under the law of which the entity is formed has changed.
4. The jurisdiction as changed is ___________________________________________________________.
5.
This document contains additional information as provided by law.
6.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant legal
consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document is/are _________________________.
(mm/dd/yyyy hour:minute am/pm)
Notice:
Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the
individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person
on whose behalf the individual is causing the document to be delivered for filing, taken in conformity with the
requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic statutes, and that the
individual in good faith believes the facts stated in the document are true and the document complies with the
requirements of that Part, the constituent documents, and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the secretary of state,
whether or not such individual is named in the document as one who has caused it to be delivered.
CHANGE_JURIS
Page 1 of 2
Rev. 11/14/2017
7. The true name and mailing
address of the individual causing
the document to be delivered for
filing are
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ _____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ _____________________________
(Province – if applicable)
(Country – if not US)
(If the following statement applies, adopt the statement by marking the box and include an attachment.)
This document contains the true name and mailing address of one or more additional individuals causing the
document to be delivered for filing.
Disclaimer:
This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice, and are
furnished without representation or warranty. While this form/cover sheet is believed to satisfy minimum legal
requirements as of its revision date, compliance with applicable law, as the same may be amended from time to
time, remains the responsibility of the user of this form/cover sheet. Questions should be addressed to the user’s
legal, business or tax advisor(s).
CHANGE_JURIS
Page 2 of 2
Rev. 11/14/2017
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