State of Utah File Number ________________________ DEPARTMENT OF COMMERCE Division of Corporations & Commercial Code Application Amending Authority to Conduct Affairs or Registration Check Here If: Non-Refundable Processing Fee: [ ] Foreign Profit Corporation $37.00 [ ] Foreign Nonprofit Corporation $37.00 [ ] Foreign Limited Partnership $37.00 [ ] Foreign Limited Liability Company $37.00 If the business name has changed its name in the home state, a copy of the Certificate of Amendment or a certified copy of the amendment must accompany this application. 1. Check either or both of the following which apply: [ ] The name of the entity is changing it's name in Utah to the new name of the corporation in the home state. [ ] The name of the entity is being changed in Utah to comply with Utah State Insurance Regulations. 2. Amending the business name: Current Name in Utah: ______________________________________________________________________ Name of Home State: _______________________________________________________________________ Business entity name in home state:____________________________________________________________ *The entity shall use as its name in Utah:________________________________________________________ If the name is not available in Utah the corporation shall use ________________________________________ *The entity shall use its name as set forth, unless this name is not available. 3. Amending the duration of the business existance The businesses period of duration is changed to:__________________________________________________ 4. Purpose of the business_____________________________________________________________________ 5. Amending the state or country of incorporation/registration The entity's state or country of incorporation/registration is changed to:________________________________ 6. Under penalties of perjury, I declare this Application to Amend the Certificate of Authority or Registration to be, to the best of my knowledge and belief, true and correct. ______________________________________ Signature ___________________________ Title ______________ Date You may file with the Division of Corporations the completed application in person, by mail, or fax. Means of payment are, cash, check, money order made payable to the "State of Utah". Please include one (1) self addressed envelope with application. If you are faxing you must include, on a cover sheet, the number of a Visa, MasterCard or American Express with the date of expiration. Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, the business entity physical address may be provided rather than the residential or private address of any individual affiliated with the entity. Mailing/Faxing Information: www.corporations.utah.gov/contactus.html Mail Website: www.corporations.utah.gov Division's In: PO Box 146705 Salt Lake City, UT 84114-6705 Walk In: 160 East 300 South, Main Floor Information Center: (801) 530-4849 Toll Free: (877) 526-3994 (within Utah) Fax: (801) 530-6438 American LegalNet, Inc. www.FormsWorkflow.com