Form Reg-C-L Request For Change Of Registration Information Page 2
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4REG-C-EA
STATE OF NEW JERSEY
Mail to: PO Box 308
Trenton, NJ 08646
(08-05
DIVISION OF REVENUE
)
BUSINESS ENTITY AMENDMENT FILING
FEE REQUIRED
Complete the following information and sign in the space provided. Please note that once filed, the information on this page is considered public.
Refer to the instructions for delivery/return options, filing fees and field-by-field requirements. Remember to remit the appropriate fee amount for this
filing. Use attachments if more space is required for any field, or if you wish to add articles for the public record.
A. Business Name:_________________________________________________________________________________________________________
Business Entity NJ 10-digit ID number:
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____
B. Statutory Authority for Amendment: _______________________________________________ (See Instructions for List of Statutory Authorities)
C. ARTICLE __________________ OF THE CERTIFICATE of the above referenced business is amended to read as follows. (If more space is
necessary, use attachment)
D. Other Provisions: (Optional)______________________________________________________________________________________________
E. Date Amendment was Adopted:____________________
F. CERTIFICATION OF CONSENT/VOTING: (If required by one of the following laws cited, certify consent/voting)
N.J.S.A. 14A:9-1 et seq. or N.J.S.A 15A:9-1 et seq., Profit and Non-Profit Corps. Amendment by the Incorporators
Amendment was adopted by unanimous consent of the Incorporators.
N.J.S.A 14A:9-2(4) and 14A:9-4(3), Profit Corps., Amendment by the Shareholders
Amendment was adopted by the Directors and thereafter adopted by the shareholders.
Number of shares outstanding at the time the amendment was adopted __________________, and total number of shares entitled to vote
thereon ______________. If applicable, list the designation and number of each class/series of shares entitled to vote:
List votes for and against amendment, and if applicable, show the vote by designation and number of each class/series of shares entitled to
vote:
Number of Shares Voting for Amendment
Number of Shares Voting Against Amendment
** If the amendment provides for the exchange, reclassification, or cancellation of issued shares, attach a statement indicating the manner in
which same shall be effected.
N.J.S.A. 15A:9-4, Non-profit Corps., Amendment by Members or Trustees
The corporation has
does not have
members.
If the corporation has members, indicate the number entitled to vote _______, and how voting was accomplished:
At a meeting of the corporation. Indicate the number VOTING FOR _____ and VOTING AGAINST _____. If any class(es) of members
may vote as a class, set forth the number of members in each class, the votes for and against by class, and the number present at the meeting:
Class
Number of Members
Voting for Amendment
Voting Against Amendment
Adoption was by unanimous written consent without a meeting.
If the corporation does not have members, indicate the total number of Trustees ___________________, and how voting was accomplished:
At a meeting of the corporation. The number of Trustees VOTING FOR ______________ and VOTING AGAINST ______________.
Adoption was by unanimous written consent without a meeting.
G.
AGENT/OFFICE CHANGE
New Registered Agent: ___________________________________________________________________________________________________
Registered Office: ( Must be a NJ street address)
Street__________________________________________________________________ City _______________________ Zip ________________
H.
SIGNATURE(S) FOR THE PUBLIC RECORD (See Instructions for Information on Signature Requirements)
Signature_________________________________________________Title ____________________________________________ Date _____________
Signature_________________________________________________Title ____________________________________________ Date _____________
The above-signed certifies that the business entity has complied with all applicable NJ statutory filing requirements
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