Application For Amended Certificate Of Authority {CORP-3(F)}

Business ID: Vermont Secretary of State APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY of a non-Vermont Corporation (profit or nonprofit) registered to do business in Vermont PLEASE RETURN EVIDENCE OF FILING TO: (Name and Address) Processed by: FOR OFFICE USE ONLY PLEASE REVIEW SUBMISSION AND FORM INSTRUCTIONS BEFORE BEGINNING THIS DOCUMENT MUST BE TYPEWRITTEN OR PRINTED (11A V.S.A. § 1.20) CORPORATION: REQUIRED ­ AS CURRENTLY ON RECORD WITH THE VERMONT SECRETARY OF STATE. a. Current Business Name: b. Domestic State: c. Date of Incorporation: CHECK THE BOX NEXT TO AND FILL-IN ONLY THOSE ARTICLES (1-10) IN WHICH INFORMATION IS BEING CHANGED/UPDATED 1. 2. 3. NEW BUSINESS NAME: NEW DOMESTIC STATE: US STATE OR NON-US COUNTRY REQUIRED ­ MUST ATTACH CERTIFICATE OF GOOD STANDING (OR EQUIVALENT) FROM SECRETARY OF STATE OF CURRENT DOMESTIC STATE, DATED WITHIN 30 DAYS OF FILING ATTACHED. FOR-PROFIT SPECIFIC PROVISION: NEW FISCAL YEAR END (Month): FOR-PROFIT CORPORATION ANNUAL REPORTS ARE DUE EACH YEAR WITHIN FIRST 2.5 MONTHS OF FISCAL YEAR END. 4. NONPROFIT SPECIFIC PROVISIONS: a. NEW BENEFIT TYPE: SELECT ONE (1) OF THE FOLLOWING This Nonprofit would be a public benefit corporation, as defined in 11B V.S.A. § 17.05, if it had been initially formed in Vermont. 5. 6. 7. This Nonprofit is no longer a member organization. NEW BUSINESS PURPOSE NAICS CODE (PREFERED) OR BRIEF STATEMENT OF Purpose: NEW TERMINATION DATE: IF ANY NEW PRINCIPAL OFFICE: a. Street Address: NO PO BOX City/Town: b. Mailing Address: City/Town: This Nonprofit would be a mutual benefit corporation, as defined in 11B V.S.A. § 17.05, if it had been initially formed in Vermont. b. NEW MEMBER ORGANIZATION STATUS: SELECT ONE (1) OF THE FOLLOWING This Nonprofit is now a member organization. PRIMARY GOODS OR SERVICES TO BE PROVIDED BY THIS CORPORATION State: ZIP: - State: ZIP: - 8. CURRENT DIRECTORS IF SELECTED ­ MUST PROVIDE COMPLETE LIST OF CURRENT (NEW AND REMAINING) DIRECTORS - PROFIT CORPORATIONS: MINIMUM 1 DIRECTOR ­ NONPROFITS: MINIMUM 3 DIRECTOR - PLEASE ATTACH CONTINUATION SHEET IF THERE ARE MORE THAN 3 DIRECTORS CURRENTLY APPOINTED. a. Director Name: Business Address: City/Town: E-Mail Address: State: ZIP: - American LegalNet, Inc. www.FormsWorkFlow.com 11A V.S.A. § 15.04/11B V.S.A. § 15.04 (REV. 07/01/15) DIVISION OF CORPORATIONS Page 1 of 2 FORM CORP-3(F) CORPORATION AMENDMENT (FOREIGN) Vermont Secretary of State APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY of a non-Vermont Corporation (profit, nonprofit, or cooperative) registered to do business in Vermont b. Director Name: Business Address: City/Town: E-Mail Address: c. Director Name: Business Address: City/Town: E-Mail Address: CHECK IF APPLICABLE: State: ZIP: - State: ZIP: - 9. This corporation now has more than three (3) directors and/or officers; PLEASE ATTACH A COMPLETE LIST OF ADDITIONAL PRINCIPLES. CURRENT OFFICERS: IF SELECTED ­ MUST PROVIDE COMPLETE LIST OF ALL CURRENT (NEW AND REMAINING) OFFICERS ­ PLEASE ATTACH CONTINUATION SHEET IF THERE ARE MORE THAN 4 OFFICERS CURRENTLY APPOINTED. a. President Name: Business Address: City/Town: E-Mail Address: b. Vice President Name: Business Address: City/Town: E-Mail Address: c. Secretary Name: Business Address: City/Town: E-Mail Address: d. Treasurer Name: Business Address: City/Town: E-Mail Address: CHECK IF APPLICABLE: State: ZIP: - State: ZIP: - State: ZIP: - State: ZIP: - 10. This corporation now has more officers than listed above. MUST ATTACH A COMPLETE LIST OF ADDITIONAL OFFICERS. FISCAL YEAR END (MONTH): ANNUAL REPORTS WILL BE DUE EACH YEAR WITHIN FIRST 2.5 MONTHS OF FISCAL YEAR END. 11. EFFECTIVE DATE OF THIS DOCUMENT: OPTIONAL - AMENDMENTS ONLY MAY BE POST-DATED UP TO 90 DAYS FROM DATE OF RECEIPT CERTIFICATION OF APPLICATION: REQUIRED I hereby certify, under penalty of law, (11A/B V.S.A. §1.29), as an officer or director of this Corporation on record with the Vermont Secretary of State prior to the filing of this document, that the above information is accurate, is provided in duplicate with a Certificate of Good Standing (or an equivalent document), dated within 30 days of filing, from the Secretary of State of the Domestic State and a Check or Money Order made payable to "VT SOS" in the amount of $25.00. Printed/Typed Name of Officer or Director Signature Date PLEASE REVIEW SUBMISSION AND FORM INSTRUCTIONS ON REVERSE BEFORE FILING. 11A V.S.A. § 15.04/11B V.S.A. § 15.04 (REV. 07/01/15) American LegalNet, Inc. www.FormsWorkFlow.com DIVISION OF CORPORATIONS Page 2 of 2 FORM CORP-3(F) CORPORATION AMENDMENT (FOREIGN) cooperative) registered to do business in Vermont Vermont Secretary of State APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY of a non-Vermont Corporation (profit, nonprofit, or SUBMISSION INSTRUCTIONS a. This form must be filed in duplicate (1 original + 1 copy ­or-- 2 originals) with a Certificate of Good Standing (or equivalent instrument), a check or money order, payable to "VT SOS," in the amount of $25.00, and a self-addressed stamped envelope. b. This form can ONLY be accepted by Mail or In-person at: c. Please allow 7-10 business days, or more, from the day that this form received in our office, for processing and (if approved) for this business appear on the website at www.vtsosonline.com, and for evidence of filing to be returned. Vermont Secretary of State Corporations Division 128 State Street Montpelier, VT 05633-1104 This form CANNOT be accepted by Phone, Fax, or E-mail; however, this filing is now available online: If you wish to submit this filing electronically, DO NOT fill out this form, please file online at https://www.vtsosonline.com/online/Account?referrer=BA. Payment for this form also CANNOT be accepted by credit card or e-check (ACH); however, payment by credit card or e-check (ACH) is available by filing online: If you wish to submit payment by credit card or e-check (ACH), DO NOT fill out this form, please file online at https://www.vtsosonline.com/online/Account?referrer=BA. Online filing normally takes 3-5 business days or less. ***THIS FILING IS NOW AVAILABLE ONLINE*** FORM INSTRUCTIONS Line 1a. Business Name. In accordance with 11A V.S.A. § 15.06/11B V.S.A. § 15.06 the name of the corporation must: (a) contain, or add for use in the state of Vermont, the word "corporation", "incorporated", "company", "limited", "professional corporation", "professional association," "service corporation"; or the abbreviation "corp," "inc," "co," "ltd," "pc," "pa," or "sc," o