Free Amendment or Correction to Biennial Report - Nebraska

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

1) Exact Name of Corporation or Limited Liability Company (exact name as stated in articles of incorporation,
articles of organization, or certificate of authority filed with the Nebraska Secretary of State):

_________________________________________________________________________________________

2) Amendment or Correction applies to the following type of Biennial Report (check only one box): Foreign Corporation Domestic Corporation Limited Liability Company 3) Years of Biennial Report being corrected (found on Tax Report form):_______________-______________ 4) Amendment or Correction is correcting or adding names of (check boxes as applicable): Officer and indicate title of office and/or Director (attach additional page if necessary) _______________________________________________________________________________
(Indicate whether change or addition is Officer (give title) or Director and provide both name and address of same)

______________________________________________________________________________
(Indicate whether change or addition is Officer (give title) or Director and provide both name and address of same)

5) Amendment or Correction is correcting Principal Office (if Corporation) and/or Street Address of Principal Place of business in Nebraska (if Limited Liability Company):
________________________________________________________________________________________ Street Address City State Zip 6) Amendment or Correction is correcting name of state or jurisdiction under whose laws a: Limited Liability company is organized or Corporation is formed: _____________________________________________ 7) Amendment or Correction is correcting Nature of Business conducted in Nebraska: _______________ _____________________________________________________________________________________ 8) Amendment or Correction is changing Location of Property Owned or Used in Nebraska: __________ _____________________________________________________________________________________ 9) Amendment or Correction is changing the Actual Value of Real Estate and Personal Property in Nebraska (if Foreign Corporation only): from $ ________________ to $________________. (Enclose additional occupation tax due for Corporation or if refund is due contact Secretary of State for refund form. Attach explanation of increase or decrease in Actual Value of Real Estate or Personal Property.) OR

Amendment or Correction is changing the Amount of Paid Up Capital Stock (if Domestic Corporation only):
from $ ________________ to $ ________________. (Enclose additional occupation tax due for Corporation or if refund is due, contact Secretary of State for refund form. Attach explanation of increase or decrease in Amount of Paid Up Capital Stock.)
_____________________________________________________________________ Signature

FILING FEES: Limited Liability Company $10.00 flat fee OR Corporation $25.00 (plus $5.00 per page recording fee). Make check payable to: Secretary of State. SOS Revised 7-18-08
Neb. Rev. Stat. § 21-2617.01, 21-301, 21-304

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 Foreign Corporation, Domestic Corporation, or Limited Liability Company as it appears in the Articles of Incorporation, Articles of Organization or Certificate of Authority filed with the Nebraska Secretary of State. 2. Type of Biennial Report being amended or corrected: Select the check box which corresponds to the type of Biennial Report this Amendment or Correction refers to either Foreign or Domestic Corporation or Limited Liability Company. 3. Tax Report-The amending party is required to submit a separate Amendment or Correction form for each prior biennial report being corrected or amended and pay applicable fee for each form to be filed (see
below).

4. Officer or Director changes or additions (for Corporations only): For a change or addition to an Officer, you must provide officer's name and the title of the office (example: President) and complete address. For Director changes or additions, provide the name of the director and complete address. 5. Address of Principal Office or Principal Place of business: Please provide the complete address if amending or correcting the Principal Office (if Corporation) or Principal Place of business in Nebraska (if Limited Liability Company). 6. Correction to Name of State or Jurisdiction: Select the check box which corresponds to the type of entity: Limited Liability Company (where organized) or Corporation (where formed) and provide the name of the state or jurisdiction under whose laws it was originally filed. 7. Nature of Business: State the amended or corrected nature of business conducted in Nebraska. 8. Location of Property Owned or Used in Nebraska: State the amended or corrected location of property owned or used in Nebraska. 9. Actual Value of Real Estate and Personal Property in Nebraska (if Foreign Corporation) OR Amount of Paid Up Capital Stock (if Domestic Corporation): Select the applicable check box for the type of corporation. Provide the original dollar amount reported on the Biennial Report being amended or corrected and the corrected dollar amount. (Enclose additional occupation tax due for reporting period or if refund is due, contact Secretary of State for refund form to submit with this Amendment or Correction. Attach explanation of increase or decrease in Actual Value of Real Estate or Personal Property (if Foreign Corporation) or Amount of Paid Up Capital Stock (if Domestic Corporation). Signature of person completing the Amendment or Correction to Biennial Report Filing fee is a $10.00 (no $5.00 per page recording fee due) for Limited Liability Company amendments or corrections and $30.00 (plus $5.00 per additional pages recording fee) for Corporations amendments or corrections. Payment must accompany the Amendment or Correction filing. Make check payable to: Secretary of State.