APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY CONNIE LAWSON SECRETARY OF STATE CORPORATIONS DIVISION 302 W. Washington Street, Room E018 Indianapolis, Indiana 46204-2700 Telephone: (317) 232-6576 www.sos.in.gov State Form 49462 (R3 / 4-12) Approved by the State Board of Accounts, 1999 INSTRUCTIONS: NOTE: Use 8 1/2" x 11" white paper for attachments Present original and one copy to address in upper right corner of this form. Please TYPE or PRINT. Please visit our office on the web at www.sos.in.gov. Indiana Code 23-18-11-5 FILING FEE: $30.00 This application must be accompanied by an original certificate of existence duly authenticated by the proper authority from the LLC's domicilary state, within the last sixty (60) days. APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY OF Name of Limited Liability Company A FOREIGN LIMITED LIABILITY COMPANY ADMITTED TO TRANSACT BUSINESS IN INDIANA The undersigned manager or member of _________________________________________________________________________ (hereinafter referred to as the "LLC"), which exists pursuant to the provisions of the laws of __________________________ as (State or county of organization) amended, desire to obtain an Amended Certificate of Authority. ARTICLE II - REPRESENTATION BY THE WITHDRAWING CORPORATION 1. The above LLC received a Certificate of Authority to transact business in the State of Indiana on the ______________ day of ___________________________________________ , ___________ . 2. The LLC desires to change its LLC name in Indiana as follows: _________________________________________________ ___________________________________________________________________________________________________. 3. The LLC has changed the period of its duration from _________________________________________________ to ___________________________________________________. 4. The LLC has changed the state or country of its organization from ______________________________________ to ______________________________________. In Witness Whereof, the undersigned, being the ________________________________________________________ of said (Manager or member) LLC executes this Application for Amended Certificate of Authority and verifies, subject to penalties of perjury, that the statements contained herein are true, this ____________ day of __________________________________ , 20_______. Signature Printed name American LegalNet, Inc. www.FormsWorkFlow.com