APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY LIMITED COOPERATIVE ASSOCIATION (FOREIGN) Submit in Duplicate , Secretary of State P.O. Box 94608 Lincoln, NE 68509 (402)471-4079www.sos.ne.Name of Limited Cooperative Association Alternative Name (only used when the associations name does not comply with Nebr. Rev. Stat. 21-2908) Organized under the laws of the State of Date original certificate of authority was filed in Nebraska The name of the organization has been changed to: Alternative Name (only used when the associations name does not comply with Neb. Rev. Stat. 21-2908) The address of the designated office in this state has been changed to: The address of the designated office in state of organization has been changed to: (if such address is required by state of organization) Name and address of registered agent in Nebraska: Registered Agent Name: Address: NE Street and Mailing Address CityZip Signature of Officer or Authorized Representative Printed name of Officer or Authorized Representative FILING FEE: For Profit $30.00 plus $5.00 per page for any additional pages Not for Profit $10.00 plus $5.00 per page for any additional pages Neb. Rev. Stat. 21-2903, 21-29,110 American LegalNet, Inc. www.FormsWorkFlow.com