Name /Address Change to Certificate of Business Please Select One: ___ Name Change (Proof of legal name change required)(Name must appear on original document) ___ Address Change Please Print or Type The expiration date for certificate shall remain the last day of the sixtieth month from the original date of filing. Original Certificate File Number __________________________________________________________ City, State of Business _______________________________________, ____________________________ (City) (State) Fictitious Firm Name (DBA) ______________________________________________________________ (Fictitious Firm Name) or (Doing Business As) Individual requesting change ______________________________________________________________ (Please Type or Print Full Name as it appears on Certificate) Signature of Individual requesting change ____________________________________________________ (Signature) (Date) Change Name From: ____________________________________________________________________ Full Name and title (Type or Print) Change Name To: _______________________________________________________________________ Full Name and title (Type or Print) Change Address From: ___________________________________________________________________ Street Address of Business or Residence City, State, Zip ___________________________________________________________________ Mailing Address, if different from above City, State, Zip Change Address To: ______________________________________________________________________ Street Address of Business or Residence City, State, Zip ______________________________________________________________________ Mailing Address, if different from above City, State, Zip Certificate Change Number __________________ Mail to: Shirley B. Parraguirre, County Clerk, Attn. FFN, P.O. Box 551604, Las Vegas NV 89155-1604 Include: Original plus 2 copies and self-addressed stamped, envelope (No Filing Fee) 02/26/04 American LegalNet, Inc. www.FormsWorkflow.com