Free F-01A - Arkansas

Arkansas Secre t a ry of State
Charlie Daniels
State Capitol · Little Rock, Arkansas 72201-1094 501-682-3409 · www.sos.arkansas.gov

Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock

Application for Amended Certificate of Authority
FILL IN COMPLETELY (Please type or print) The undersigned pursuant to the Arkansas Business Corporation Act of 1987, (Act 958 of 1987), sets forth the following: 1. is a foreign corporation authorized to transact business within the State of Arkansas.

2. The Certificate of Authority should be amended as follows: Corporate name to: Fictitious name to be used in Arkansas to: . .

(The corporation may use a fictitious name to transact business in Arkansas if its real name is unavailable and it delivers to the Secretary of State for filing a copy of the resolution of its Board of Directors certified by the Secretary adopting a fictitious name. Period of Duration to: State or Country of incorporation to: 3. The state, territory or foreign country under whose laws the corporation was incorporated is: 4. Date Incorporated: Period of Duration: . . .

5. The nature of the business of the corporation and the object or purposes proposed to be transacted, promoted or carried on by it are: .

6. The name and street address of the registered agent of the corporation upon whom Service of Process is authorized to be made in Arkansas is:
(Street Address) (City) (State) (ZIP)

7. The address of the general office or principal place of business of the corporation in the jurisdiction under whose laws the corporation was incorporated is:

8. The number and par value, if any, of shares of the corporation's capital stock owned or to be owned by residents of this state:

.
9. Value of assets in Arkansas: $ Total Value of all assets (including Arkansas): $ . 10. The foreign corporation shall deliver with the completed application an original certified copy of the amendment dated within 60 days of our receipt duly authorized by the Secretary of State or other official having custody of corporate records in the state or country under whose laws it is incorporated. 11. A filing fee of $300.00 is submitted herewith in accordance with Act 958 of 1987.

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
Authorizing Officer and Title (Type or Print)

Authorized Signature

Fee: $300.00 payable to Arkansas Secretary of State

F-01 A/Rev. 4/06