Free Amendment or Correction to Biennial Report - Nebraska

Amendment or Correction to Biennial Report LIMITED COOPERATIVE ASSOCIATION
John A. Gale, Secretary of State Room 1301 State Capitol, P. O. Box 94608 Lincoln, NE 68509 (402) 471-4079

1) Name of Limited Cooperative Association (as stated in the articles of organization, or certificate of authority filed with the Nebraska Secretary of State): __________________________________________ _____________________________________________________________________________________ 2) Foreign limited cooperative association ONLY: Alternative Name: ____________________________ ____________________________________________________________________________________ 3) Year of Biennial Report being corrected (found on Report form): _______________ - _______________ 4) Amendment or Correction to the Designated Office: ___________________________________________________________________NE_______________ Street and Mailing Address City Zip 5) Amendment or Correction to Name or Address of the Agent for Service of Process in Nebraska:
_____________________________________________________________________________________________________ Name of Agent for Service of Process

_________________________________________________________________________NE ________________ Street and Mailing Address of Agent for Service of Process City Zip 6) Amendment of Correction to Principal Office: _________________________________________________________________________NE_________________ Street and Mailing Address City Zip

7) Foreign limited cooperative ONLY-Amendment or Correction of the name of the state or other jurisdiction under whose laws the limited cooperative association was formed: _____________________
_____________________________________________________________________________________________________

Signature of Officer or Authorized Representative Required FILING FEE: For Profit $30.00 plus $5.00 per page for any additional pages Not for profit $10.00 plus $5.00 per page for any additional pages 1/1/2008 Neb. Rev. Stat. § 21-2923

INSTRUCTIONS FOR COMPLETING AMENDMENT OR CORRECTION TO BIENNIAL REPORT FORM

NOTE: A separate Amendment or Correction form and fee must be submitted for each Biennial Report form to be amended or corrected

1. Name: Please state the exact name of the Limited Cooperative Association as it appears in the Articles of Organization or Certificate of Authority filed with the Nebraska Secretary of State. 2. Foreign limited cooperative associations ONLY: If you where required to choose an alternative name to use in Nebraska list the alternative name here. 3. Year of report being corrected: Give the year of the report you are amending/correction (found on report). 4. Designated Office: Please provide the complete street and mailing address of the designated office. 5. Name and address of agent for service of process: Only corrections to errors made on the biennial report can be made by filing this form. Any changes to the information must be accomplished by filing a separate change of registered agent and/or office form. 6. Address Principal Office: Please provide the complete street and mailing address of the principal office in Nebraska. 7. Correction to Name of State or other Jurisdiction: Provide the name of the state or other jurisdiction under whose laws the limited cooperative association was formed.