This form must be type written or computer generated.
           State of Utah                                                                                                                  Print
           Department of Commerce                                                                                                         Clear Form
           Division of Corporations & Commercial Code 
           Amendment         to Authority to Conduct Affairs for a Foreign Corporation 
Non-Refundable Processing Fee $37.00 

File Number: _________________________ 
Current Name in Utah: ________________________________________________________________________           
Principal Office:______________________________________________________________________________ 
1.Amending the business name:
   
   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.

If the business name has changed its name in the home state, a certified copy of the amendment or a Certificate of 
Fact name change must accompany this application.  
Check either or both of the following which apply: 
    [   ] The name of the entity is changing its 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 duration of the business existence
   The businesses period of duration is changed to: _________________________________________________

3.Purpose of the business:  ____________________________________________________________________

4.Amending the state or country of incorporation
   The entity's state or country of incorporation is changed to: __________________________________________

Under penalties of perjury, I declare this Amendment to Authority to Conduct Affairs for a Foreign Corporation 
to be, to the best of my knowledge and belief, true and correct. 
Signature: ___________________________________Sign here after the form is printed                 Title: __________________________ 

Date:  __________________ 
Under GRAMA {63G-2-201}, all registration information maintained by the Division is classified as public record.  For confidentiality purposes, you 
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. 
Mailing/Faxing Information: www.corporations.utah.gov/contactus.html                Division's Website: www.corporations.utah.gov

01/14