Amendment Or Correction To Biennial Report

Amendment or Correction to Domestic Limited Liability Company Biennial Report , Secretary of State P O. Box 94608 Lincoln, NE 68509 (402)471-4079 1)Exact Name of Limited Liability Company: 2)Year(s) of Biennial Report to be amended or corrected: - 3)Amended or Corrected Street Address of the Principal Office: Street Address City State Zip Signature Printed Name Title Date FILING FEES: $10.00 Make check payable to: Secretary of State Revised Neb. Rev. Stat. 247 21-125 Page 1 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING DOMESTIC LIMITED LIABILITY COMPANY AMENDMENT OR CORRECTION TO BIENNIAL REPORT 1.Exact Name of Limited Liability Company: As stated in the certificate of organization or mostrecent amendment. 2.Year(s) of Biennial Report to be amended or corrected. A separate form and fee must besubmitted for each Biennial Report to be amended or corrected. 3.Principal Office address: Provide complete street address. The following information on the biennial report cannot be amended or corrected on this form, but may be modified by filing the designated form below: Registered Agent and/or Registered Office: You must file the Statement of Change of Designated Office, Registered Agent and/or Registered Agent222s Address form found on our website at http://www.sos.ne.gov/business/corpserv/corpform.html . This form may be uploaded and filed online using the Corporate Document eDelivery. Street address of the Designated Office: You must file the Statement of Change of Designated Office, Registered Agent and/or Registered Agent222s Address form found on our website at http://www.sos.ne.gov/business/corpserv/corpform.html . This form may be uploaded and filed online using the Corporate Document eDelivery. Page 2 American LegalNet, Inc. www.FormsWorkFlow.com