State of Missouri
D WE S T ITE
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Robin Carnahan, Secretary of State
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The below-named corporation, relating to amending its Certificate of Authority of Foreign Corporation, does hereby state: 1. Its name is it is incorporated in the State of: in the State of Missouri on
month/day/year
2. By appropriate corporate action on:
month/day/year
1. Changed its corporate name to: Name it will use in Missouri if new name not available: 2. Changed its period of duration to: 3. Changed the state or country of its incorporation to: 3. There is attached hereto a Certificate of the Secretary of State of the State of relating to the amendment(s) set forth in item 2 above and showing that the Corporation is in existence and in good standing in said State. The effective date of this document is the date it is filed by the Secretary of State of Missouri unless a future date is otherwise indicated:
In Affirmation thereof, the facts stated above are true and correct: (The undersigned understands that false statements made in this filing are subject to the penalites provided under Section 575.040, RSMo)
Authorized signature of officer or chairman of the board
Attached is a current (not more than 60 days old) certificate attesting to the change, duly authenticated and certified by the secretary of state or other official having custody of corporate records in the state or country of incorporation.
Name and address to return filed document: Name: Address: City, State, and Zip Code:
Corp. 52A (11/2008)
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Corporations Division PO Box 778 / 600 W. Main St., Rm. 322 Jefferson City, MO 65102
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Application for an Amended Certificate of Authority for a Foreign Nonprofit Corporation
(Submit with filing fee of $10.00)
Missouri Charter #:
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; and it was qualified . the corporation:
(Date may not be more than 90 days after the filing date in this office)
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