Foreign Nonprofit Corporation Application For Amended Certificate Of Authority Form - Wyoming Page 2

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10. The names and usual business addresses of its current officers and directors:
Office
Name
Address
President
Vice President
Secretary
Treasurer
Director
Director
Director
11. Does this corporation have members?
Yes
No
12. If this corporation had been incorporated under the laws of the state of Wyoming, would it be:
(Check appropriate choice.)
a. Public benefit corporation
b. Mutual benefit corporation
c. Religious corporation
13. The corporation accepts the constitution of the state of Wyoming in compliance with the requirement of Article
10, Section 5, of the Wyoming Constitution.
14. For name availability purposes list the type of business the nonprofit corporation will be conducting:
Date:
Signature: ___________________________________________
(mm/dd/yyyy)
(May be executed by Chairman of Board, President or another of its officers.)
Print Name:
Title:
Contact Person:
Daytime Phone Number:
Email:
Checklist
Filing Fee: $10.00 Make check or money order payable to Wyoming Secretary of State.
The completed application must be accompanied by an original CERTIFICATE OF EVIDENCE of the
Amendment, or a document of similar import, dated not more than sixty (60) days prior to filing in
Wyoming. If the amendment involves a name change, the certificate must state the previous name and the
new name along with the date of the amendment.
For consistency the Secretary of State’s Office will only keep one version of the agent’s name on file.
Please submit one originally signed document and one exact photocopy of the filing.
Please review form prior to submitting to the Secretary of State to ensure all areas have been
completed to avoid a delay in the processing of your documents.
FNP-AmendedCertificateAuthority - Revised 11/2012

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