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StateJohn R. Ashcroft,of MissouriSecretary of State
Corporations Division
PO Box 778 / 600 W. Main St., Rm. 322
Jefferson City, MO 65102
Application for an Amended Certificate of
Authority for a Foreign Corporation
(Submit with filing fee of $25.00)
The below corporation, relating to amending its certificate of authority of Foreign Corporation, does hereby state:
1. Its name is: Missouri Charter #:
Incorporated in the State of: ;
Qualified in the State of Missouri on .
month/day/year
2. By appropriate corporate action on: , the corporation:
month/day/year
Changed its corporate name to:
Nameit will use in Missouri if new name not available:
Changed its period of duration to:
Changed the state or country of its incorporation to:
3. There is attached hereto a Certificate of the Secretary of State or other state authority of the State of
relating to the amendment(s), set forth in item 2 above and showing that the Corporation is in existence and in good standing in said
State. (Certificate must be less than 60 days old.)
4. Any other amendments to the certificate:
5. The effective date of this document is the date it is filed by the Secretary of State of Missouri, unless you indicate a future date, as
follows:
(Datemaynotbemorethan90daysafterthefilingdateinthisoffice)
In Affirmation thereof, the facts stated above are true and correct:
(The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575.040, RSMo)
Authorized Signature Printed Name Title month/day/year
Attached is an original current certificate attesting to the change, duly authenticated by the secretary of state or other official having
custody of corporate records in the state or country of incorporation.
Name and address to return filed document:
Name:
Address:
City, State, and Zip Code:
Corp. 43 (01/2017)
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