Amended Certificate Of Authority Application Form - Secretary Of State - 2011
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1APPLICATION FOR AMENDED
CERTIFICATE OF AUTHORITY
(Non-Profit Corporations)
, Secretary of State
John A. Gale
Room 1301 State Capitol, P.O. Box 94608
Lincoln, NE 68509
Submit in Duplicate
Attach a certificate stating the name change amendment duly authenticated by the official
having custody of the corporate records in the state or country under whose law it is
incorporated. Such certificate shall not be more than 60 days old.
Name of Corporation_____________________________________________________
Incorporated under the laws of______________________________________________
Amended Name of Corporation_____________________________________________
Date Incorporation_________________, _____ Period of Duration________________
Year
Corporate Type (check one) ____ Public Benefit ____ Mutual Benefit ____ Religious
Does the Corporation Have Members? ____ Yes ____ No
Address of Principal Office________________________________________________
Street Address
City
State
Zip
Registered Agent________________________________________________________
Registered Office___________________________________________NE__________
Street Address and Post Office Box (if any) City
Zip
Effective date if other than the date filed ___________
_______________________________
___________________________________
Signature
Printed Name/Title
NOTE: Every filing must be signed by the chairperson of the board of directors, the president, or one of the officers
of the corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing shall
be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed
fiduciary, the filing shall be signed by that fiduciary.
FILING FEE: $10.00 plus $5.00 per page for attachments & for the certificate (if
required)
Revised 12/2011
Neb. Rev. Stat. 21-19,149
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