ROSS MILLER Secretary of State 202 North Carson Street Carson City, Nevada 89701-4201 (775) 684-5708 Website: www.nvsos.gov *021001* Nevada State Business License *021001* Certificate of Amendment For Sole Proprietors and Partnerships Only 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 sole proprietors and partnerships holding a State Business License. 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 the sole proprietor or a partner of the partnership. 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) Your Name or Name of Partnership 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 the sole proprietor or partner of the partnership 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 X Signature Date Nevada Secretary of State Busn License Amend SP&P Revised: 8-3-10 American LegalNet, Inc. www.FormsWorkFlow.com