Form 179-Fam - Certificate Of Amendment To Foreign Corporation Application For License

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J. Kenneth Blackwell
Prescribed by
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CERTIFICATE OF AMENDMENT TO
FOREIGN CORPORATION APPLICATION FOR LICENSE
(Name of Corporation - Including Assumed Name if Applicable)
, does hereby certify that the above named Foreign
(Authorized Officer and Title)
Corporation formed in the state of
with license number
has modified the information set forth in the original Application for License or any Amendment thereto with the following:
1.
The name of the corporation has been amended to
2.
The corporation's principal office shall be located in
(street address)
(city, township, or village)
(state)
(zip code)
3.
The corporation's principal office within Ohio shall be located in
, Ohio
(city, township, or village)
(county)
(zip code)
4. The corporation hereby appoints the following as the statutory agent upon whom process against the corporation may be
served in the state of Ohio. The name and complete address of the statutory agent is:
(name of statutory agent)
(street and number)
, Ohio
(city, village or township)
(zip code)
5.
The corporation will exercise the following corporate purpose(s) in Ohio:
6.
The corporation has currently authorized
shares of stock and has issued
shares.
7.
This certificate of amendment supersedes the information currently on file with the Secretary of State of Ohio.
This Certificate of Amendment to the Foreign Corporation Application for License has been adopted in accordance with the laws
of the state of domestication.
IN WITNESS WHEREOF, this Certificate of Amendment of a Foreign Corporation has been executed on
(date)
Signature:
(Authorized Officer)
179-FAM
Page 1 of 1
Version: 7/15/99

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