State Form 49462 - Application For Amended Certificate Of Authority
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APPLICATION FOR AMENDED
CONNIE LAWSON
CERTIFICATE OF AUTHORITY
SECRETARY OF STATE
CORPORATIONS DIVISION
State Form 49462 (R3 / 4-12)
302 W. Washington Street, Room E018
Approved by the State Board of Accounts, 1999
Indianapolis, Indiana 46204-2700
Telephone: (317) 232-6576
Use 8 1/2" x 11" white paper for attachments
INSTRUCTIONS:
Present original and one copy to address in upper right corner of this form.
Indiana Code 23-18-11-5
Please TYPE or PRINT.
FILING FEE: $30.00
Please visit our office on the web at .
NOTE: This application must be accompanied by an original certificate of existence duly authenticated by the proper authority from the
LLC's domicilary state, within the last sixty (60) days.
APPLICATION FOR
AMENDED CERTIFICATE OF AUTHORITY
OF
Name of Limited Liability Company
A FOREIGN LIMITED LIABILITY COMPANY ADMITTED TO
TRANSACT BUSINESS IN INDIANA
The undersigned manager or member of _________________________________________________________________________
(hereinafter referred to as the "LLC"), which exists pursuant to the provisions of the laws of __________________________ as
(State or county of organization)
amended, desire to obtain an Amended Certificate of Authority.
ARTICLE II - REPRESENTATION BY THE WITHDRAWING CORPORATION
1. The above LLC received a Certificate of Authority to transact business in the State of Indiana on the ______________ day of
___________________________________________ , ___________ .
2. The LLC desires to change its LLC name in Indiana as follows: _________________________________________________
___________________________________________________________________________________________________.
3. The LLC has changed the period of its duration from _________________________________________________ to
___________________________________________________.
4. The LLC has changed the state or country of its organization from ______________________________________ to
______________________________________.
In Witness Whereof, the undersigned, being the ________________________________________________________ of said
(Manager or member)
LLC executes this Application for Amended Certificate of Authority and verifies, subject to penalties of perjury, that the
statements contained herein are true, this ____________ day of __________________________________ , 20_______.
Signature
Printed name
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Parent category: Financial