Amendment Or Correction To Biennial Report - 2013
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1
2Amendment or Correction to
Biennial Report
John A. Gale, Secretary of State
Room 1301 State Capitol, P. O. Box 94608
Lincoln, NE 68509
(402) 471-4079
1) Exact Name of Corporation
(exact name as stated in articles of incorporation or certificate of authority filed with the
:
Nebraska Secretary of State)
_________________________________________________________________________________________
2) Amendment or Correction applies to the following type of Biennial Report
:
(check only one box)
Foreign Corporation
Domestic Corporation
3) Years of Biennial Report being corrected
:_______________-______________
(found on Report form)
(note you must file a separate form for each reporting period being corrected)
4) Amendment or Correction is correcting or adding names of
:
(check boxes as applicable)
Officer and indicate title of office and/or
Director
(attach additional page if necessary)
_______________________________________________________________________________
(Indicate whether change or addition is Officer (give title) or Director and provide both name and address of same)
______________________________________________________________________________
(Indicate whether change or addition is Officer (give title) or Director and provide both name and address of same)
5) Amendment or Correction is correcting Principal Office
:
________________________________________________________________________________________
Street Address
City
State
Zip
orporation is
6) Amendment or Correction is correcting name of state or jurisdiction under whose laws the c
formed
: _____________________________________________
7) Amendment or Correction is correcting Nature of Business conducted in Nebraska: _______________
_____________________________________________________________________________________
8) Amendment or Correction is changing Location of Property Owned or Used in Nebraska: __________
_____________________________________________________________________________________
9)
Amendment or Correction is changing the Actual Value of Real Estate and Personal Property in Nebraska
(if
: from $ ________________ to $________________. (Enclose additional occupation tax
Foreign Corporation only)
due for Corporation or if refund is due contact Secretary of State for refund form. Attach explanation of increase or
decrease in Actual Value of Real Estate or Personal Property.)
OR
Amendment or Correction is changing the Amount of Paid Up Capital Stock
(if Domestic Corporation only):
from $ ________________ to $ ________________. (Enclose additional occupation tax due for Corporation or if
refund is due, contact Secretary of State for refund form. Attach explanation of increase or decrease in Amount of
Paid Up Capital Stock.)
_____________________________________________________________________
Signature
FILING FEES: $30.00 (plus $5.00 for any additional pages).
Make check payable to: Secretary of State.
SOS
Revised February 5, 2013
Neb. Rev. Stat. § 21-301, 21-304
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