Secretary of State OFFICE OF SECRETARY OF STATE CORPOR A TIONS DIVISION 2 Martin Luther King Jr. Dr. SE Suite 313 West Tower Atlanta, GA 30334 (404) 656 - 2817 sos.georgia.gov/corporations APPLICATIO N FO R AMENDED CERTIFICAT E O F AUTHORITY OF A FOREIGN ENTITY An amen d ed certificate of authority m u st be obtained by filing an application for amen d ed certificate of authority if a foreign entity ch a ng e s its na m e or its jur i sd i c tion of org a nization . If any other information required in the original application has changed, please use this form , attaching additional pages if necessary, to inform the Secretary of State of said changes . Complete (where a ppl i c a b le) and return this f o rm wi t h a ch ec k p a S amount of $ 2 0.00. 1. Enti t y Name: 2. Entity Control N umber : 3. Entity T y pe (ch e ck one only) : Corpor a t i o n (choose one type) Profit Nonprofit Professional (Corporation must provide certificate of existence from home state with new name, if applicable.) Limited Liabili t y Compa n y Limited Partner s hip /Limited Liability Limited Partnership Limited Liabili t y Partnership 4. State/Country of Home Jurisdiction: 5. Date of Authorization in Georgia: 6. New Entity Type (if applicable): Corporation (choose one type) Profit Nonprofit Professional (Corporation must provide certificate of existence from home state with new name, if applicable.) Limited Liability Company Limited Partnership/Limited Liability Limited Partnership Limited Liability Partnership 7. New Name of Entity (if applicable): 8. New Home Jurisdiction (if applicable): 9. Effective Date: (Choose one) Upon filing Delayed effective date and/or time: (A delayed effective date must be within 90 days of the filing date.) 10. Signa t ure Date Print Name ( c h eck one only) : Corp o ration: Officer Chairperson of Board of Directors Court - Appointed Fiduciary Attorney - in - fact LLC: Member Ma n a g er Court - Appointed Fiduciary Attorney - in - fact LP /LLLP : Gen e ral Partn e r Attorney - in - fact LLP: Authorized Person Email Address : F orm C D 5 18 (Rev. 10 /2018 ) American LegalNet, Inc. www.FormsWorkFlow.com