Free 635_0114.p65 - Iowa

MICHAEL A. MAURO Secretary of State State of Iowa

APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY

TO THE SECRETARY OF STATE OF THE STATE OF IOWA: Pursuant to section 1504 of the Iowa Business Corporation Act, the undersigned corporation applies for an amended certificate of authority to transact business in Iowa, and states:

1. The name of the corporation is _____________________________________________________________ and the name the corporation uses in Iowa if different than its real name is _____________________________________________________________________________________ The corporate name has been changed to ____________________________________________________

2. The state [or foreign country] of incorporation on the records of the Secretary of State of Iowa is _____________________________________________________________________________________ The state [or foreign country] of incorporation has been changed to _________________________________

3. The duration of the corporation on the records of the Secretary of State of Iowa is ______________________ The duration has been changed to __________________________________________________________

4. The date of incorporation of the corporation was ________________________________________________

5. The street address of its principal office is address _______________________________________________________________________________ city, state, zip __________________________________________________________________________

6. The street address of its registered office in Iowa and the name of its registered agent at that office: name _________________________________________________________________________________ address _______________________________________________________________________________ city, state, zip __________________________________________________________________________

7. The names and business addresses of its current directors and officers: name _________________________________________________________________________________ address _______________________________________________________________________________ city, state, zip __________________________________________________________________________

635_0114 04/07

name _________________________________________________________________________________ address _______________________________________________________________________________ city, state, zip __________________________________________________________________________

name _________________________________________________________________________________ address _______________________________________________________________________________ city, state, zip __________________________________________________________________________

name _________________________________________________________________________________ address _______________________________________________________________________________ city, state, zip __________________________________________________________________________
Please attach additional pages if needed.

8. A certificate of existence, or a document of similar import, duly authenticated by the official having custody of corporate records in the state or country of incorporation, accompanies this application. 9. Signature ______________________________________________________________________________ Type or print name and title _______________________________________________________________

NOTES: 1. The filing fee is $100.00. Make checks payable to SECRETARY OF STATE. 2. The document is to be signed by the chairperson of the board, the president, or other officer of the corporation. If directors have not been selected, the document is to be signed by an incorporator. If the corporation is in the hands of a court appointed fiduciary, the document is to be signed by the fiduciary. A copy of a signature is acceptable for filing. Verification is not required. 3. One copy of the document is to be delivered to the Secretary of State for filing. 4. The effective time and date of the document is the later of the following: a. the time of filing on the date it is filed; b. the time specified in the document on the date it is filed; c. the time and date specified in the document, not later than 90 days after the date it is filed. 5. The information you provide will be open to public inspection under Iowa Code chapter 22.11.

SECRETARY OF STATE Business Services Division Lucas Building, 1st Floor Des Moines, Iowa 50319 Phone: (515) 281-5204 FAX: (515) 242-5953 or (515) 281-7142 Website: www.sos.state.ia.us