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                                                                                                           SECRETARY OF STATE 
                FOREIGN REGISTRATION AMENDMENT                                                            BUSINESS SERVICES DIVISION 
                State Form 56365 (R4 / 6-19)                                                         302 West Washington Street, Room E018 
                                                                                                           Indianapolis, IN 46204 
                                                                                                          Telephone: (317) 232-6576 
                                                                                                           www.sos.in.gov  
INSTRUCTIONS:  1. Use 8½” x 11” white paper for attachments. 
    2. Please   or         TYPE PRINT in INK.  
                   3. Please visit our office on the web at www.sos.IN.gov 
                   4. Make check or money order payable to the Secretary of State.  
                   5. Submit original completed paperwork and payment to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204. 
 
REQUIREMENTS:  Applicants must submit a certificate of existence issued by the proper authority within the last sixty (60) days. 
 
NOTE:   A registered foreign entity must submit a copy of this form if there is any change in the name of the entity, the entity's  
        jurisdiction of formation, the street address of the entity, or the registered agent information. 
 
                INFORMATION CONTAINED ON THIS PAGE IS NOT PART OF THE PUBLIC RECORD. 
 
Name of business 
 
E-mail address of business (SOS use only) 
 
RETURN DOCUMENTS TO: 
 
Name 
 
Street address, line 1 
 
Street address, line 2 
 
City                                                         State                                        ZIP code 
                                                                                                           
Telephone number                             E-mail address (If different from above – SOS use only) 
                                              
(     )                                            
 

           FOREIGN REGISTRATION AMENDMENT 
           State Form 56365 (R4 / 6-19) 
           
The undersigned, desiring to amend the registration of a foreign entity on file with the Secretary of State pursuant to the provisions of Indiana Code  
23-0.5-5-4, executes the following Foreign Registration Amendment. 
 
                                                    ARTICLE I –ENTITY INFORMATION 
Current legal name of the entity  
      
Current alternate name of the entity (if any) 
      
Date the foreign entity registered with the Secretary of State's office (month, day, year) 
      
Current entity type  
      
Current jurisdiction of formation  
      
                                                    ARTICLE II – NEW ENTITY INFORMATION 
                                     Please complete only the sections pertaining to the information that has changed. 
Please note: If the entity changing its name is a Foreign Master LLC, Articles of Designation changing the name of each associated Series must be 
submitted to the Secretary of State's office along with this Amendment. 
New legal name of the entity  
      
New alternate name of the entity 
      
New jurisdiction of formation  
      
If the foreign entity is a Foreign Limited Liability Company that wishes to become a Foreign Master LLC, please provide the name of the Foreign Master LLC. 
(The name must include the words Limited Liability Company-S, L.l.C.-S or LLC-S.)   
Name of the Foreign Master LLC 
      
The Master LLC is authorized to designate one or more series. 
If the foreign entity is a Foreign Master LLC that wishes to become a Foreign Limited Liability Company, please provide the name of the Foreign Limited 
Liability Company. (The name must include the words Limited Liability Company,L.L.C.             or LLC.) 
Name of the Foreign Limited Liability Company 
      
This Limited Liability Company removes the statement from its Registration Statement that it is authorized to designate one or more series. 
By filing this Amendment, all associated series to the Master LLC will be dissolved. 
New street address: 
Number and street                                                                                         City            State ZIP code 
                                                                                                                                      
                                                    ARTICLE III – REGISTERED AGENT INFORMATION 
To determine if your Registered Agent is a Commercial Registered Agent (CRA), go to INBIZ.in.gov.  
Provide either commercial registered agent or noncommercial registered agent information below. 
                                              Name of registered agent (Do not provide address.) 
  Commercial registered agent                       
OR 
                                              Name of registered agent 
  Noncommercial registered agent                    
Address (number and street) (A P.O. Box is not acceptable unless accompanied by a Rural Route number.)    City            State ZIP code 
                                                                                                                          IN          
(OPTIONAL) E-mail address of the registered agent at which the registered agent will accept electronic service of process 
      
   By checking the box, the Signator(s) represent(s) that the Registered Agent named in the Foreign Registration Amendment has consented to the  
   appointment of Registered Agent. 
                                                                        Page 1 of 2 

In Witness Whereof, the undersigned duly authorized representative of the foreign entity executes this Foreign Registration Amendment and verifies,  
 
subject to penalties of perjury, that the statements contained herein are true, this ______ day of ________________________, 20______. 
Signature 

Printed name Title 
                   
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