Application for Amended Certificate of Authority The undersigned pursuant to the Act of 19, sets forth the following: 1.is a foreign corporation authorized to transact business within the State of Arkansas.2.The Certificate of Authority should be amended as follows:Corporate name to:.Fictitious name to be used in Arkansas to:.(The corporation may use a fictitious name to transact business in Arkansas if its real name is unavailable and it delivers to theSecretary of State for filing a copy of the resolution of its Board of Directors certified by the Secretary adopting a fictitious name.Period of Duration to:.State or Country of incorporation to:.3.The state, territory or foreign country under whose laws the corporation was incorporated is:4.Date Incorporated:Period of Duration:. The nature of the business of the corporation and the object or purposes proposed to be transacted, promoted orcarried on by it are: .The name and street address of the registered agent of the corporation upon whom Service of Process is authorized to be madein Arkansas (Street Address) (City) (State)(ZIP)7.The address of the general office or principal place of business of the corporation in the jurisdiction under whose lawsthe corporation was incorporated is:8.The number and par value, if any, of shares of the corporation's capital stock owned or to be owned by residents of this state:.9.Value of assets in Arkansas: $Total Value of all assets (including Arkansas): $.10.The foreign corporation shall deliver with the completed application an original certified copy of the amendment datedwithin 60 days of our receipt duly authorized by the Secretary of State or other official having custody of corporaterecords in the state or country under whose laws it is incorporated.11.Afiling fee of $300.00 is submitted herewith in accordance with Act 958 of 1987.I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of Stateis a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.Authorizing Officer and Title (Type or Print)Authorized SignatureFee: $300.00 payable to Arkansas Secretary of State 001027021n024030n030007r013027r031n027035025016007031n031r$'#$t 003n026020031025022037004020031031022r006025013021 () American LegalNet, Inc. www.FormsWorkFlow.com