Certificate Of Amendment (Other)
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Certificate Of Amendment (Other) Form. This is a Nevada form and can be use in State Business License (Non Title 7) Secretary Of State.
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Tags: Certificate Of Amendment (Other), Nevada Secretary Of State, State Business License (Non Title 7)
ROSS MILLER
Secretary of State
202 North Carson Street
Carson City, Nevada 89701-4201
(775) 684-5708
Website: www.nvsos.gov
*021101*
Nevada State
Business License
*021101*
Certificate of
Amendment
"Other"
USE BLACK INK ONLY - DO NOT HIGHLIGHT
ABOVE SPACE IS FOR OFFICE USE ONLY
Completing this form does not relieve you of any statutory or regulatory requirements relating to your business.
This form is for the use of a business that is not a sole proprietor or partnership or that is not required to organize
pursuant to Title 7 of NRS. It MAY NOT be used by those entities organized and on file with the Secretary of State that
file an annual list.
* Asterisks indicate required information. Incomplete forms will be rejected.
INSTRUCTIONS:
1. Print legibly or type all information on this form.
2. Enter the name and NV Business ID # exactly as shown on State Business License certificate and as on file with the Secretary of State.
3. File online at www.nvsos.gov, or,
4. Return the completed form to: Secretary of State, 202 North Carson Street, Carson City, Nevada, 89701-4201, (775) 684-5708.
5. This form must be signed by a responsible party. FORM WILL BE RETURNED IF UNSIGNED.
1* Name as it appears on Business License
2* NV Business ID #
(NV Secretary of State - issued, may be found on State Business License)
3 The State Business License is hereby amended as follows:
(Check the box of the information you are changing)
Entity Name
IMPORTANT: Name change requires document certifying a legal name change. If this is not provided, amendment will be rejected.
Phone # (
)
Physical
Address
Physical Street Address
City
State
Zip Code
Mailing
Address
PO Box or Street Address
City
State
Zip Code
Email
Address
4* Signature must be that of a responsible party of the entity amending the State Business License.
I declare under penalty of perjury that the information provided is true, correct and complete to the best of my knowledge and belief and
acknowledge that pursuant to NRS 239.330, it is a category C felony to knowingly offer any false or forged instrument for filing in the Office of the
Secretary of State.
First Name
Middle (Optional)
Last Name
Suffix
Title
X
Signature
Date
Nevada Secretary of State Busn License Amend Other
Revised: 8-3-10
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