Form Cd 920 - Amended Annual Registration For Limited Liability Company Page 2
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1
2OFFICE OF SECRETARY OF STATE
CORPORATIONS DIVISION
2 Martin Luther King Jr. Dr. SE
Suite 313 West Tower
Atlanta, Georgia 30334
(404) 656-2817
Brian P. Kemp
Secretary of State
AMENDED ANNUAL REGISTRATION
FOR LIMITED LIABILITY COMPANY
Note: In order to use this amended annual registration form, an annual registration must have already been filed for the
limited liability company in this calendar year. Amended annual registration filing fee is $20.00.
Entity Information:
1.
Entity Name: _______________________________________________________________________________
Entity Control Number: ______________________________________
Entity Type (check one only):
Domestic Limited Liability Company
Foreign Limited Liability Company
2. Name of current registered agent on file with the Secretary of State:
__________________________________________________________________________________________
3. Current street address and county of registered office on file with the Secretary of State:
Address: ____________________________________________________________________________________________
____________________________________________________________________________________________
City: _____________________________
County: ________________________
State: GA
Zip Code: _____________
4. If applicable, name of new registered agent: ____________________________________________________
Email address of new registered agent: __________________________________________________________
5. If applicable, new street address and county of registered office:
Address: ____________________________________________________________________________________________
____________________________________________________________________________________________
City: ______________________________ County: _________________________ State: GA
Zip Code: _____________
6. If applicable, new mailing address of entity’s principal office:
Address: ____________________________________________________________________________________________
____________________________________________________________________________________________
City: _______________________________________________________
State: _________
Zip Code: _____________
7. I hereby certify, under penalty of law, that the above information is true and correct.
____________________________________________________
_________________________________
Signature of Authorized Person
Date
____________________________________________________
_________________________________
Print Name
Title
Form CD 920
(Rev. 8/2016)
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