Document processing fee If document is filed on paper $150.00 If document is filed electronically Currently Not Available Fees & forms/cover sheets are subject to change. To file electronically, access instructions for this form/cover sheet and other information or print copies of filed documents, visit www.sos.state.co.us and select Business Center. Paper documents must be typewritten or machine printed. ABOVE SPACE FOR OFFICE USE ONLY Statement of Correction filed pursuant to §7-90-305 and, if applicable, §7-90-703 of the Colorado Revised Statutes (C.R.S) Document number _____________________ (of filed document to be corrected) ID number _____________________ 1. Entity name ______________________________________________________ 2. True name (if different from the entity name) ______________________________________________________ The corrected statement(s) below correct(s) the corresponding incorrect statement(s) that is/are contained in the filed document identified by the document number above. Complete the following sections as applicable. Leave the section blank if it does not apply. You must complete section 21. 3. Corrections made below are intended to update the entity’s current information OR Corrections made below are intended for historical purposes only, and not to update the entity’s . current information 4. Correction of entity name of record ______________________________________________________ 5. Correction of true name of record ______________________________________________________ 6. Correction of entity form of record ______________________________________________________ 7. Correction of jurisdiction of formation of record ______________________________________________________ 8. Correction of registered agent of record (if an individual) ____________________ ______________ ______________ _____ (Last) OR (if a business organization) (First) (Middle) (Suffix) ______________________________________________________ The person appointed as registered agent in the document has consented to being so appointed. CORRECT Page 1 of 4 Rev. 8/22/2008 American LegalNet, Inc. www.FormsWorkflow.com If the correction is being effected by the registered agent, the following statement applies: The person appointed as registered agent has delivered notice of the correction to the entity at the principal office address of its principal office. 9. Correction of registered agent street address of record ______________________________________________________ (Street name and number) ______________________________________________________ __________________________ (City) CO ____________________ (State) (Postal/Zip Code) If the correction is being effected by the registered agent, the following statement applies: The person appointed as registered agent has delivered notice of the correction to the entity at the principal office address of its principal office. 10. Correction of registered agent mailing address of record* (if different from above) ______________________________________________________ (Street name and number or Post Office information) ______________________________________________________ __________________________ _____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) *If this address is being deleted entirely, mark this box (Country – if not US) . If the correction is being effected by the registered agent, the following statement applies: The person appointed as registered agent has delivered notice of the correction to the entity at the principal office address of its principal office. 11. (If the following statement applies, adopt the statement by marking the box.) The person appointed as the registered agent for the entity in the document identified above has not consented to be appointed as registered agent or is otherwise not the registered agent for the entity. Such person has delivered notice of the correction to the entity. 12. Correction of principal office street address of record ______________________________________________________ (Street name and number) ______________________________________________________ __________________________ _____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) 13. Correction of principal office mailing address of record* (if different from above) (Country – if not US) ______________________________________________________ (Street name and number or Post Office information) ______________________________________________________ __________________________ _____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) *If this address is being deleted entirely, mark this box CORRECT Page 2 of 4 (Country – if not US) . Rev. 8/22/2008 American LegalNet, Inc. www.FormsWorkflow.com 14. Correction of delayed effective date of record ______________________ (only for filed documents that have not become effective) (mm/dd/yyyy) 15. Correction of period of duration of record If the entity’s period of duration as corrected is perpetual, mark this box OR If period of duration is less than perpetual, state the date on which the period of duration expires: _____________________ (mm/dd/yyyy) 16. If other information contained in the filed document is being corrected, mark this box attachment stating the information to be corrected and each such correction. and include an 17. Correction regarding unauthorized filed document (if the filed document should not have been filed, mark this box and include an attachment stating each incorrect statement that is corrected by the statement of correction). (only for filed documents that have become effective) 18. If this statement of correction affects another record in the records of the Secretary of State, mark this and include an attachment stating the entity name, true name, trade name, or trademark and the box identification number of that record. . 19. If this statement of correction affects this record’s status, mark this box 20. (If this statement of correction revokes a filed document that states a delayed effective date but has not yet become effective, adopt the following statement by marking the box.) The filed document is revoked. Notice: Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic statutes, and that the individual in good faith believes the facts stated in the document are true and the document complies with the requirements of that Part, the constituent documents, and the organic statutes. This perjury notice applies to each individual who causes this document to be delivered to the secretary of state, whether or not such individual is named in the document as one who has caused it to be delivered. 21. Name(s) and address(es) of the individual(s) causing the document to be delivered for filing: ____________________ ______________ ______________ _____ (Last) (First) (Middle) (Suffix) ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) CORRECT Page 3 of 4 (Country – if not US) Rev. 8/22/2008 American LegalNet, Inc. www.FormsWorkflow.com (The document need not state the true name and address of more than one individual. However, if you wish to state the name and address of any additional individuals causing the document to be delivered for filing, mark this box name and address of such individuals.) and include an attachment stating the Disclaimer: This form, and any related instructions, are not intended to provide legal, business or tax advice, and are offered as a public service without representation or warranty. While this form is believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form. Questions should be addressed to the user’s attorney. CORRECT Page 4 of 4 Rev. 8/22/2008 American LegalNet, Inc. www.FormsWorkflow.com