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Matt Blunt, Secretary of State
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Corporations Division
P.O. Box 778 / 600 W. Main Street, Rm 322
Jefferson City, MO 65102
Application for an Amended Certificate of
Authority for a Foreign Nonprofit Corporation
(Submit in duplicate with filing fee of $10.00)
The below-named corporation, relating to amending its Certificate of Authority of Foreign Corporation, does hereby state:
(1)
Its name is: __________________________________________________________________________________________;
it is incorporated in the State of: _________________________________________________________; and it was qualified
in the State of Missouri on ______________________________________________________________________________.
(month/day/year)
(2)
By appropriate corporate action on: __________________________________________________________ the corporation:
(month/day/year)
(1)
Changed its corporate name to: ___________________________________________________________________
Name it will use in Missouri if new name not available: ________________________________________________
(2)
Changed its period of duration to: _________________________________________________________________
(3)
Changed the state or country of its incorporation to: ___________________________________________________
(3)
There is attached hereto a Certificate of the Secretary of State of the State of _______________________________________
relating to the amendment(s) set forth in item 2 above and showing that the Corporation is in existence and in good standing
in said State.
(4)
The effective date of this document is the date it is filed by the Secretary of State of Missouri, unless you indicate a future
date, as follows: ______________________________________________________________________________________
(Date may not be more than 90 days after the filing date in this office)
In affirmation of the facts stated above,
____________________________________________________________________________________________________________
(authorized signature of officer or chairman of the board)
(Printed Name)
(Title)
(Date)
Attached is a current certificate attesting to the change, duly authenticated and certified by the secretary of state or other official
having custody of corporate records in the state or country of incorporation.
Corp. #53B (12/02)