OFFICE OF SECRETARY OF STATE
CORPORATIONS DIVISION
2 Martin Luther King Jr. Dr. SE
Suite 313 West Tower
Atlanta, GA 30334
(404) 656-2817
sos.georgia.gov/corporations
Brian P. Kemp
Secretary of State
APPLICATION FOR AMENDED
CERTIFICATE OF AUTHORITY
OF A FOREIGN ENTITY
An amended certificate of authority must be obtained by filing an application for amended certificate of authority if a
foreign entity changes its name or its jurisdiction of organization. If any other information required in the original
application has changed, please use this form, attaching additional pages if necessary, to inform the Secretary of State
of said changes. Complete (where applicable) and return this form with a check payable to “Secretary of State” in the
amount of $20.00.
1. Entity Name: ___________________________________________________________________________
2. Entity Control Number: ___________________________________________________________________
3. Entity Type (check one only):
Corporation (choose one type)
Profit
Nonprofit
Professional
(Corporation must provide certificate of existence from home state with new name, if applicable.)
Limited Liability Company
Limited Partnership/Limited Liability Limited Partnership
Limited Liability Partnership
4. State/Country of Home Jurisdiction: ________________________________________________________
5. Date of Authorization in Georgia: __________________________________________________________
6. New Entity Type (if applicable):
Corporation (choose one type)
Profit
Nonprofit
Professional
(Corporation must provide certificate of existence from home state with new name, if applicable.)
Limited Liability Company
Limited Partnership/Limited Liability Limited Partnership
Limited Liability Partnership
7. New Name of Entity (if applicable): __________________________________________________________
8. New Home Jurisdiction (if applicable): _______________________________________________________
9. Effective Date: (Choose one)
Upon filing
Delayed effective date and/or time: ________________
(A delayed effective date must be within 90 days of the filing date.)
10. _______________________________________________________
________________________
Signature
Date
_______________________________________________________
Print Name
Signer’s Capacity (check one only):
Corporation:
Officer
Chairperson of Board of Directors
Court-Appointed Fiduciary
Attorney-in-fact
LLC:
Member
Manager
Court-Appointed Fiduciary
Attorney-in-fact
LP/LLLP:
General Partner
Attorney-in-fact
LLP:
Authorized Person
Email Address: _____________________________________________________________
Form CD 518
(Rev. 1/2018)
1
Form 635_0114 - Application For Amended Certificate Of Authority - Ia Secretary Of State - 2012
Legal
Form Flc-2 - Application For Amended Certificate Of Authority Of Foreign Limited Liability Company
Legal
