C-113A Rev. 12/93 New Jersey Division of Revenue Application for Amended Certificate of Authority (For Use by Foreign Profit and Non-profit Corporations) Check Appropriate Statute: ___ N.J.S.A. 14A:13-6 ___ N.J.S.A. 15A:13-6 New Jersey Profit Corporation Act (File in Duplicate) New Jersey Nonprofit Corporation (File in Triplicate) Pursuant to the provisions of the appropriate Statute, checked above, of the New Jersey Statutes, the undersigned corporation hereby applies for an Amended Certificate of Authority, and for this purpose certifies to the following: 1. Original corporate name: 2. New Jersey corporate number: 3. New name of corporation (if applicable): 4. Incorporated under the laws of: The date of foreign incorporation: 5. The duration of the corporation is: 6. The address of its main office or headquarters is: (Street and postal designation) (City) (State) (Zip) 7. The name and address of its Registered agent in New Jersey is: (Agent's Name) (Street and postal designation) (City) (State) (Zip) Said Registered Agent is an agent of the corporation upon whom process against the corporation may be served. 8. The business/activities which the corporation is authorized to conduct in New Jersey, and which it is also authorized to conduct in its home jurisdiction are: NOTE: Attach a Good Standing Certificate from the home state dated no more than 30 days prior to filing in New Jersey. Signature: Title: (Must be Chairperson of the Board, President, or Vice President) Date: American LegalNet, Inc. www.USCourtForms.com Rev 7/7/05 Instructions for Form C-113A CERTIFICATE OF AMENDMENT FOREIGN PROFIT and NON- PROFIT CORPORATIONS (Titles 14A and 15A) STATUTORY FEE: $75 The MANDATORY fields are: Statutory Authority Indicate by checking the appropriate statutory authority: 14A:13-6 or 15A:13-6. Field # 1 -- Business Name List the name as it appears on the records of the State Treasurer. If you are changing the corporate name (see Field # 3), then name availability provisions apply. ** **The name must be distinguishable from other names on the State's database. The Division of Revenue will check the proposed name for availability as part of the filing review process. If desired, you can reserve/register a name prior to submitting your filing by obtaining a reservation/registration. For information on name availability reservation/registration services and fees, visit the Division's WEB site at http://www.state.nj.us/treasury/revenue/certcomm.htm or call (609) 292-9292 MondayFriday, 8:30 a.m. - 4:30 p.m. Field # 2 -- Number List the ten-digit ID as it appears on the records of the State Treasurer. Field # 4 -- Home Jurisdiction/Date List the state, territory, possession, or other jurisdiction or country where the foreign corporation was incorporated. Also, provide the date on which the corporation was incorporated in the home jurisdiction. Field #6 -- Principal (Main) Address List the principal or main address of the corporation. Field #7 -- Registered Agent and Office List the agent and office as shown on the records of the State Treasurer. Field #8 -- Purpose List the purpose of the corporation (a brief descriptive statement regarding the type of business that the corporation is conducting). CERTIFICATE Provide a certificate of good standing/existence from the home jurisdiction not greater than 30 days old. EXECUTION (DATE/SIGNATURE) The president, vice-president or chairman of the board must sign. Also, list the execution (signature) date. **************** These documents should be filed in duplicate. Non-profits should file in triplicate. Make checks payable to: TREASURER, DIVISION OF REVENUE. (No cash, please) Mail to: NJ Division of Revenue, PO Box 308, Trenton, NJ 08646 American LegalNet, Inc. www.USCourtForms.com