Application For Amended Certificate Of Authority

Filing Fee: $30.00, plus $5.00 per page for attachments & for the certificate (if required). Revised Neb. Rev. Stat. 24421-2, 206 APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY , Secretary of State P.O. Box 94608 Lincoln, NE 68509 Attach a certificate stating the name change amendment duly authenticated by the official having custody of the corporate records in the state or country under whose law it is incorporated. Such certificate shall not be more than 60 days old. A certified copy of the name change amendment should not be submitted and is not acceptable in lieu of such certificate. Name of Corporation Incorporated under the laws of Amended Name of Corporation Date Incorporation, Year Period of Duration Address of Principal Office Street Address City State Zip Registered Agent Registered OfficeNE Street Address and Post Office Box number (if any) City Zip Effective date if other than date filed SignaturePrinted Name/Title NOTE: Every filing must be signed by the chairperson of the board of directors, the president, or one of the officers of the corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing shall be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed fiduciary, the filing shall be signed by that fiduciary. American LegalNet, Inc. www.FormsWorkFlow.com