Expedite this Form: (Select One)Prescribed by J. Kenneth Blackwell Ohio Secretary of StateMail Form to one of the Following:PO Box 1390 Columbus, OH 43216Central Ohio: (614) 466-3910YesToll Free: 1-877-SOS-FILE (1-877-767-3453)*** Requires an additional fee of $100 ***www.state.oh.us/sos e-mail: busserv@sos.state.oh.usPO Box 1028 Columbus, OH 43216NoCERTIFICATE OF AMENDMENT TOFOR LICENSE FOREIGN CORPORATION APPLICATION(For Foreign, Profit or Non-Profit ) Filing Fee $50.00(1)Foreign for Profit(2)Foreign Non-Profit License No.License No. (179-FAM)(179-FAM)Complete the following information in this section if box (1) or (2) is checked., does hereby certify that the above named Foreign(Authorized Officer and Title) (Name of Corporation -Including Assumed Name if Applicable)Corporation formed in the state of has modified the information set forth in the original Application for License or any Amendment thereto with the following:The name of the corporation has been amended toThe corporation's principal office shall be located in(street address)NOTE: P.O. Box Addresses are NOT acceptable.(city, township, or village)(zip code)(state)The corporation's principal office within Ohio shall be located inCheck box if there is no Ohio Location, Ohio(city, township, or village)(county)(zip code)American LegalNet, Inc. www.USCourtForms.comLast Revised: May 2002Page 1 of 3565Complete the following information in this section if box (1) or (2) is checked Cont.The corporation will exercise the following corporate purpose(s) in Ohio:This certificate of amendment supersedes the information currently on file with the Secretary of State of Ohio. This Certificate of Amendment to the Foreign Corporation Application for License has been adopted in accordance with the laws of the state of domestication.Must be authenticated (signed) by an authorized representativeAuthorized Representative REQUIREDDateAmerican LegalNet, Inc. www.USCourtForms.comLast Revised: May 2002Page 2 of 3565Use Tab key to move between entry fields 1. If some of the information contained in the original Application for License has not changed, you may leave the corresponding information on this form blank. InstructionsAmerican LegalNet, Inc. www.USCourtForms.com
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