214 APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY (Instructions on back of application) To the Secretary of State of the State of Idaho: Pursuant to Section 30-1-1504, Idaho Code, the undersigned Corporation hereby applies for an amended certificate of authority to transact business in the State of Idaho and for that purpose submits the following statement. Complete only applicable items. 1. A Certificate of Authority was issued to the corporation by your office on: ___________________________ , authorizing it to transact business in the State of Idaho under the name of: ___________________________________________________________________________________ . 2. Its corporate name has been changed to: ___________________________________________________ . 3. The name which it shall use hereafter in the State of Idaho is: ___________________________________________________________________________________ 4. It has changed its jurisdiction of incorporation, without a change of corporate identity to: _______________ . Dated: __________________________ Corporation Name: _______________________________________ Signature: _________________________________________________________ Typed Name: _________________________________________________________ Capacity: _________________________________________________________ Customer Acct # : (if using pre-paid account) g:\corp\forms\corpforms\ amended cert of authority.p65 Revised 07/2002 Secretary of State use only American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS Optional: If the document is incorrect where can you be reached for corrections? Note: Complete and submit the application in duplicate. 1. Line 1 - Enter the date the original application for certificate of authority was filed with this office and the name of the corporation as it currently is filed with the Office of the Idaho Secretary of State. 2. Line 2 - If the amendment is a change of name you must list the new name of the corporation. The application must be accompanied by an original certificate from the proper filing officer in the jurisdiction of incorporation evidencing the name change. Please note that the certificate required is a one page document. A certified copy of the articles of amendment or merger would not be acceptable. 3. Line 3 - Complete item 3 only if: (1) the corporation must adopt a fictitious name to avoid a conflict with an existing name on the records of the Secretary of State, or (2) the corporation's true name does not include one of the words of incorporation required by section 30-1-401, Idaho Code, and such word is added to the true name in item 3. A corporate name must include corporation, incorporated, company, limited, or any abbreviation thereof. If a fictitious name is adopted to avoid a conflict, attach a resolution of the board of directors adopting the assumed name. 4. Line 4 -If the amendment is a change of jurisdiction of incorporation, the change must not involve a change of identity, e.g. a change by merger into a shell in the new jurisdiction. If the change is by merger, the surviving corporation must file a new application for certificate of authority. Item 4 on the application applies only to a change of jurisdiction pursuant to a statute of the new jurisdiction which permits redomestication. In such case, the application must be accompanied by an original certificate from the proper filing officer in the new jurisdiction of incorporation evidencing the re-domestication. 5. The application must be signed by an officer of the corporation. Please identify the name of the signer by typing his/her name below the signature and indicate in what capacity he/she signs. (For example: President, Secretary, etc.) 6. Enclose the appropriate fee: a. b. c. d. If the form is typed, the filing fee is $30.00 If the form is not typed, the fee is $50.00 If expedited service is requested, add $20.00 to the filing fee. If the fees are to be paid from the filing party’s pre-paid customer account, conspicuously indicate the customer account number in the cover letter or transmittal document. Pursuant to Idaho Code § 67-910(6), the Secretary of State’s Office may delete a business entity filing from our database if payment for the filing is not completed. 7. Mail or deliver to: Idaho Secretary of State State Office of the Secretary of 450 NWestStreet 700 4th Jefferson - Basement West PO Box 83720 PO Box 83720 Boise ID 83720-0080 Boise ID 83720-0080 8. If you have questions or need help, call the Secretary of State’s office at (208) 334-2301. American LegalNet, Inc. www.FormsWorkflow.com