Form 39034 - Application For Amended Certificate Of Authority For A Foreign Corporation - 2016 Page 2
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1
2APPLICATION FOR AMENDED CERTIFICATE
OF AUTHORITY FOR A FOREIGN CORPORATION
State Form 39034 (R11 / 7-16), Corporate Form 115
Approved by State Board of Accounts, 2016
Indiana Code 23-1-49-4
23-1-18-3
23-17-26-4
23-17-29-3
FILING FEE: $30.00
APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY
OF
___________________________________________________________________________
Name of Corporation
A FOREIGN CORPORATION ADMITTED TO
TRANSACT BUSINESS IN INDIANA
The undersigned officers of __________________________________________________________________________________
(hereinafter referred to as the "Corporation"), which exists pursuant to the provisions of the laws of __________________________
as amended, desire to obtain an Amended Certificate of Authority.
1.
The above Corporation received a Certificate of Authority to transact business in the State of Indiana on the _____________
day of __________________________, 20____.
2.
The Corporation desires to change its corporate name in Indiana as follows:
___________________________________________________________________________________________________
3.
The Corporation has changed the period of its duration
From (month, day, year)__________________________ To (month, day, year)___________________________________
4.
The Corporation has changed the state or country of its incorporation
From ________________________________________
To __________________________________________________
5.
The Corporation has converted the entity type to a ___________________________________________________________
In Witness Whereof, the undersigned being the ___________________________________________________________ of said
Title
Corporation 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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