Free 49462.PDF - Indiana

APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY
Sta te Form 4 9462 (R/1 -03) Appro ved by th e S tate Board of Accounts, 1999

TODD ROKITA SE CRETARY OF STATE CORPORATIONS DIVISION 302 W. Wa shi ngton St., Rm . E01 8 Indian apolis, IN 462 04 Teleph one: (31 7) 2 32-65 76 In diana Code 23-1 8-11-5

INSTRUCTIONS:

Use 8 1/2" x 11" white paper for attachments Present original and one copy to address in upper right corner of this form. Please TYPE or PRINT. Please visit our office on the web at www.sos.in.gov.

FILING FEE: $30.00

NOTE:

This application must be accompanied by an original certificate of existence duly authenticated by the proper authority from the LLC's domicilary state, within the last sixty (60) days.

APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY OF

Name o f Limite d L iability Company

A FOREIGN LIMITED LIABILITY COMPANY ADMITTED TO TRANSACT BUSINESS IN INDIANA

The undersigned manager or member of _________________________________________________________________________ (hereinafter referred to as the "LLC"), which exists pursuant to the provisions of the laws of __________________________ as
(State or coun ty o f orga nizati on)

amended, desire to obtain an Amended Certificate of Authority.

ARTICLE II - REPRESENTATION BY THE WITHDRAWING CORPORATION

1. The above LLC received a Certificate of Authority to transact business in the State of Indiana on the ______________ day of ___________________________________________ , ___________ .

2. The LLC desires to change its LLC name in Indiana as follows: _________________________________________________ ___________________________________________________________________________________________________.

3. The LLC has changed the period of its duration from _________________________________________________ to ___________________________________________________.

4. The LLC has changed the state or country of its organization from ______________________________________ to ______________________________________.

In Witness Whereof, the undersigned, being the ________________________________________________________ of said
(Ma nager or member)

LLC executes this Application for Amended Certificate of Authority and verifies, subject to penalties of perjury, that the statements contained herein are true, this ____________ day of __________________________________ , 20_______.
Signature Printed name