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Form Ss-4231 - Application For Amended Certificate Of Authority (Limited Liability Company)

For Office Use Only

APPLICATION FOR AMENDED

CERTIFICATE OF AUTHORITY

Corporate Filings

(LIMITED LIABILITY COMPANY)

312 Eighth Avenue North

6 th Floor, William R. Snodgrass Tower

Nashville, TN 37243

To the Secretary of State of the State of Tennessee:

Pursuant to the provisions of § 48-246-303 of the Tennessee Limited Liability Company Act, the undersigned hereby

applies for an amended certificate of authority to transact business in the State of Tennessee, and for that purpose

sets forth:

1. The name of the Limited Liability Company is:

If different, the name under which the certificate of authority is to be obtained is:

2. The state or country under whose law it is organized is:

3. The date of its formation is:

(must be month, day and year).

4. The complete street address (including zip code) of its principal office is:

Street

City

State/Country

Zip Code

5. The complete street address (including the county and the zip code) of its registered office in

Tennessee is:

Street

City/State

County

Zip Code

The name of its registered agent at that office is:

6. Please insert the number of members at the date of filing.

NOTE: This application must be accompanied by a certificate of existence (or a document of similar import)

duly authenticated by the Secretary of State or other official having custody of Limited Liability Company

records in the state or country under whose law it is formed. The certificate shall not bear a date of more

than two (2) month prior to the date the application is successfully filed in Tennessee.

Signature Date

Name of Limited Liability Company

Signer’s Capacity

Signature

Name (typed or printed)

SS-4231 (Rev. 7/00)

RDA 2458

Form Ss-4231 - Application For Amended Certificate Of Authority (Limited Liability Company)