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                                STATE OF SOUTH CAROLINA 
                                              SECRETARY OF STATE 

                                NONPROFIT CORPORATION 
                                ARTICLES OF AMENDMENT 

Pursuant to the provisions of Section 33-31-1005 of the 1976 S.C.Code of Laws, as amended, the applicant delivers to 
the Secretary of State these articles of amendment: 

1.  The name of the nonprofit corporation is (must match name on record with Secretary of State):

2. Date incorporated (must match date on record with Secretary of State):             __________

3. On __________(date the amendment was decided upon), the following amendment was adopted: 

4. By checking this paragraph #4 the applicant represents that (a) approval of the amendment by the members 
was not required, (b) the amendment was approved by a sufficient vote of the board of directors or the 
incorporators. (Do not check this paragraph #4 if member vote was required or if the required vote of directors or 
incorporators was not obtained.

5. If the approval of the members was required to adopt the amendment(s), provide the following information: 

                                                                         Complete one of the following as appropriate: 

Designation      Number of   Number of           Number of Votes     Number of                             Total Number 
(classes of       Memberships    Votes Entitled  of Each Class       Votes Cast*                           of undisputed 
membership)    Outstanding      to be Cast by     Voting                  For   -AND-    Against   votes cast for 
                                  each Class                                                               approval 

__________   _____________  ______________  ______________  _____________  _____________ ____________ 
__________   _____________  ______________  ______________  _____________  _____________ ____________ 
__________   _____________  ______________  ______________  _____________  _____________ ____________ 
__________   _____________  ______________  ______________  _____________  _____________ ____________ 

6. By checking this paragraph #6 the applicant represents that approval of the amendment by some person or
   persons other than the members, the board, or the incorporators is required pursuant to Section 33-31-1030 of 
   the 1976 S.C. Code of Laws, as amended, and that the approval was obtained. (Do not mark paragraph #6 if 
   either of these statements is not true.)

                                                               Form Revised by South Carolina Secretary of State, August 2016 
                                                                                                                    F0084 



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                                      Name of Corporation 

7.  If the amendment provides for an exchange, reclassification, or cancellation of memberships, provisions for 
implementing the amendment must be set forth here if provisions are not contained in the amendment itself:

8. If this corporation is converting from either a public benefit or religious corporation into a mutual benefit
   corporation, mark this paragraph #8 which certifies that a notice, including a copy of the proposed amendment,
   was delivered to the South Carolina Attorney General at least twenty days before the consummation of the
   amendment.

Date: __________ 

Name of Corporation: 

_____________________________________________________________________________________________ 
(Signature of Officer) 

_____________________________________________________________________________________________ 
(Print Name) 

_____________________________________________________________________________________________ 
(Position of Officer) 

                                      Form Revised by South Carolina Secretary of State, August 2016 
                                                                                                                F0084 



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    FILING INSTRUCTIONS
 • Two copies of this form must be submitted for filing.
 • Filing fee of $10.00 payable to the Secretary of State
 • A self addressed stamped return envelope.
 • If the space in this form is insufficient, please attach additional sheets containing a reference to 
   the appropriate paragraph in this form, or prepare this using a computer disk which will allow for 
   expansion of space on the form.

   Mail to:   Secretary of State
    Attn: Corporations
    1205 Pendleton St, Suite 525
    Columbia, SC 29201

                                            Form Revised by South Carolina Secretary of State, August 2016 
                                                                                                        F0084 






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