(Leave this portion blank if no change is being made to the name.)(This office shall immediately transmit a notice of issuance of a certificate of transfer to the proper officer of the jurisdiction to which the profit corporationis transferred.)(If mail is received at a Post Office Box, please list above in addition to the physical address.) The following certifications must be completed in order for the Certificate of Transfer to be valid. The signatory executing the document must initial next to each line. (Shall be executed by Chairman of the Board, President or another its officers.) (mm/dd/yyyy) (Email provided will receive filing evidence) *May list multiple email addresses Filing Fee: $50.00