Free Foreign Application for Amended Certificate of Authority - Nebraska

APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY LIMITED COOPERATIVE ASSOCIATION
(FOREIGN) Submit in Duplicate

John A. Gale, Secretary of State Room 1301 State Capitol, P.O. Box 94608 Lincoln, NE 68509 (402) 471-4079 http://www.sos.state.ne.us Name of Limited Cooperative Association ___________________________________ ______________________________________________________________________ Alternative Name _______________________________________________________ (only used when the associations name does not comply with Nebr. Rev. Stat. 21-2908) Organized under the laws of the State of ___________________________________ Date original certificate of authority was filed in Nebraska ______________________ The name of the organization has been changed to: ______________________________________________________________________ Alternative Name _______________________________________________________ (only used when the associations name does not comply with Neb. Rev. Stat. 21-2908) The address of the designated office in this state has been changed to: ______________________________________________________________________ The address of the designated office in state of organization has been changed to: (if such address is required by state of organization)____________________________________ Name and address of registered agent in Nebraska: Registered Agent Name:___________________________________________________ Address: _____________________________________________NE_______________
Street and Mailing Address City Zip

____________________________________
Signature of Officer or Authorized Representative

__________________________________
Printed name of Officer or Authorized Representative

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. 21-2903, 21-29,110