Wyoming Secretary of State State Capitol Building, Room 110 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: business@state.wy.us For Office Use Only Foreign Limited Liability Company Application for Amended Certificate of Authority Pursuant to W.S. 17-16-1504 of the Wyoming Business Corporation Act, the undersigned limited liability company hereby applies for an Amended Certificate of Authority to transact business in the state of Wyoming, and for that purpose submits the following statement: 1. A Certificate of Authority was issued to the company by the Wyoming Secretary of State on , (Date – mm/dd/yyyy) authorizing it to transact business in Wyoming and is presently registered under the name of: 2. Name of the limited liability company has been changed to: 3. State or country of organization has been changed to: 4. Organized under the laws of: (State or country of organization) 5. Date of organization: (Date – mm/dd/yyyy) 6. Period of duration: 7. Principal office address: 8. Mailing address of the limited liability company: 9. Name and physical address of its registered agent: (The registered agent may be an individual resident in Wyoming, a domestic corporation, or foreign corporation authorized to transact business in Wyoming, having a business office identical with such registered office. The registered agent must have a physical address in Wyoming. A Post Office Box or Drop Box is not acceptable. If the registered office includes a suite number, it must be included in the registered office address.) American LegalNet, Inc. www.FormsWorkFlow.com 10. If the company is managed by a manager or managers, the names and addresses of such managers: If the management of the company is reserved to the members, the names and addresses of its members: 11. An estimate, expressed in dollars, of the value of the property of the limited liability company located and employed in the state of Wyoming: $ Date: Signature: ___________________________________________ (mm/dd/yyyy) (May be executed by a member, manager, or other authorized individual as set forth in the operating agreement.) Print Name: Title: Contact Person: Daytime Phone Number: Checklist Filing Fee: $50.00 Make check or money order payable to Wyoming Secretary of State. The completed application must be accompanied by an original CERTIFICATE OF EVIDENCE of the Amendment, or a document of similar import, dated not more than sixty (60) days prior to filing in Wyoming. If the amendment involves a name change, the certificate must state the previous name and the new name along with the date of the amendment. Please submit one originally signed document and one exact photocopy of the filing. For consistency the Secretary of State’s Office will only keep one version of the agent’s name on file. Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in the processing of your documents. FLLC-AmendedCertificateAuthority - Revised 12/2008 American LegalNet, Inc. www.FormsWorkFlow.com