Form C-113a - Application For Amended Certificate Of Authority Form

New Jersey Division of Revenue & Enterprise Services

C-113A Rev. 3/2013

APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY

(For Use by Foreign Profit and Non-profit Corporations)

To file electronically:

1. Enter the information requested below and sign by typing your name in the signature field. The form can only be filled in using the free Adobe

Acrobat Reader 9.1 or greater. (See the pages following this form for field by field instructions, and notes on delivery and processing of work requests.)

2. Click the "Add Attachments" button to add attachments if required (Check the field by field instructions to see if you must include an attachment(s)).

3. After the form has been filled in properly, please save a copy to your computer so that you can upload the form to the State of New Jersey Division of

Revenue & Enterprise Services Central Forms Repository Web application by following the instructions in the next step.

4. Click the "Open the Central Forms Repository Home Page to start the Form Submission Process" button at the bottom of the form.

(This action will launch the State of New Jersey Division of Revenue & Enterprise Services Central Forms Repository Web application. If you have not

created an account in the application, you will need to do so before using the online Web application. Once your account is created, please login to the

application and follow the instructions for submitting your form and payment online.)

Check Appropriate Statute:

___ N.J.S.A. 14A:13-6

New Jersey Profit Corporation Act

___ N.J.S.A. 15A:13-6

New Jersey Nonprofit Corporation

Pursuant to the provisions of the appropriate Statute, checked above, of the New Jersey Statutes, the

undersigned corporation hereby applies for an Amended Certificate of Authority, and for this purpose certifies

to the following:

1. Original corporate name: ___________________________________________________________________

2. NJ 10 digit ID Number: __________________________

3. New name of corporation (if applicable):

_____________________________________________________________________________________

4. Incorporated under the laws of: ____________________________

The date of foreign incorporation: __________________

5. The duration of the corporation is: ____________________________________________________

6. The address of its main office or headquarters is:

(Street and postal designation) _______________________________________________________

(City) ___________________________ (State) ___________________

(Zip) _________________

7. The name and address of its Registered agent in New Jersey is:

(Agent's Name) ______________________________________

(Street and postal designation) ________________________________________________________

(City) ____________________________ (State) ___________________

(Zip) _________________

Said Registered Agent is an agent of the corporation upon whom process against the corporation may be

served.

8. The business/activities which the corporation is authorized to conduct in New Jersey, and which it is also

authorized to conduct in its home jurisdiction are:

NOTE: Attach a Good Standing Certificate from the home state dated no more than 30 days prior to filing in

New Jersey.

Signature: ____________________________________

Date: ___________________

Title: ________________________________________

(Must be Chairperson of the Board, President, or Vice President)

Add Attachments

Open the Central Forms Repository Home Page to start the Form Submission Process

Form C-113a - Application For Amended Certificate Of Authority Form - 2013

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