Amendment or Correction to Non-Profit Corporation Biennial Report , Secretary of State P.O. Box 94608 Lincoln, NE 68509 (402)471-4079 1)Exact Name of Corporation: 2)Year of Biennial Report to be amended or corrected: Only complete the following information you wish to amend or correct. 3)Name, title and address of Officers and Directors: Indicate if you are adding, replacing or deleting.(Attach additional page if needed.) 4)Principal Office Address: Street Address City State Zip 5)Nature of Business: Signature Printed Name Title Date FILING FEES: $10.00 (plus $5.00 for any additional pages) Make check payable to: Secretary of State Revised Neb. Rev. Stat. 247 21-19,172 Page 1 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING NON-PROFIT CORPORATION AMENDMENT OR CORRECTION TO BIENNIAL REPORT The following information must be completed: 1.Exact Name of Corporation: As stated in the articles of incorporation, certificate of authority ormost recent amendment. 2.Year of Biennial Report to be amended or corrected. A separate form and fee must be submittedfor each Biennial Report to be amended or corrected. Only complete the following information being amended or corrected: 3.Officers and/or Directors: Indicate if you are replacing, adding or deleting the officer and/ordirector. Give name, title and complete address for each. 4.Principal Office Address: Complete street address required. 5.Nature of Business: Provide a description of the nature of business conducted in Nebraska. The following information on the biennial report cannot be amended or corrected on this form, but may be changed by filing the designated form below: Registered Office and/or Registered Agent: You must file the Change or Registered Agent and/or Office form found on our website at http://www.sos.ne.gov/business/corpserv/corpform.html . This form may be uploaded and filed online using the Corporate Document eDelivery. State or jurisdiction under whose laws the corporation is formed: You must file the Application for Amended Certificate of Authority form found on our website at http://www.sos.ne.gov/business/corpserv/corpform.html . This form may be uploaded and filed online using the Corporate Document eDelivery. To amend or correct if the corporation does or does not have members or if the corporation is a Public Benefit Corporation, Mutual Benefit Corporation or Religious Corporation you must file separate documents. For domestic corporations you must file Articles of Amendment following Nebraska statute 247 21-19,109. Once you have this document prepared it may be uploaded and filed online using the Corporate Document eDelivery. For foreign corporations you must file the Application for Amended Certificate of Authority form found on our website at http://www.sos.ne.gov/business/corpserv/corpform.html . This form may be uploaded and filed online using the Corporate Document eDelivery. Page 2 American LegalNet, Inc. www.FormsWorkFlow.com