Certificate Of Amendment To Foreign Licensed Corporation Application {565}

Page 1 of 4Form 565Last Revised: 06/2019 Toll Free: 877.767.3453 | Central Ohio: 614.466.3910 OhioSoS.gov | business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Filing Form Cover LetterPlease return the approval certificate to: Address: City: ZIP Code: Phone Number: E-mail Address: Check here if you would like to receive important notices via e-mail from the Ohio Secretary of State's office regarding Business Services. Check here if you would like to be signed up for our Filing Notification System for the business entity being created or updated by filing this form. This is a free service provided to notify you via e-mail when any document is filed on your business record. Please make checks or money orders payable to: "Ohio Secretary of State" Type of Service Being Requested: (PLEASE CHECK ONE BOX BELOW) Regular Service: Only the filing fee listed on page one of the form is required and the filing will be processed in approximately 3-7 business days. The processing time may vary based on the volume of filings received by our office. Expedite Service 1: By including an Expedite fee of $100.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 2 business days after it is received by our office. Expedite Service 2: By including an Expedite fee of $200.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 1 business day after it is received by our office. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Expedite Service 3: By including an Expedite fee of $300.00, in addition to the regular filing fee on page one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00 p.m. This service is only available to walk-in customers who hand deliver the document to the Client Service Center. Preclearance Filing: A filing form, to be submitted at a later date for processing, may be submitted to be examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The Preclearance will be complete within 1-2 business days. Name (Individual or Business Name): To the Attention of (if necessary): State American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 4Form 565Last Revised: 06/2019Toll Free: 877.767.3453 Central Ohio: 614.466.3910 OhioSoS.gov business@OhioSoS.gov File online or for more information: OhioBusinessCentral.gov Mail this form to one of the following: Regular Filing (non expedite) P.O. Box 1329 Columbus, OH 43216 Expedite Filing (Two business day processing time. Requires an additional $100.00) P.O. Box 1390 Columbus, OH 43216 The information provided below supersedes the information currently on file with the Ohio Secretary of State's Office. (as registered in Jurisdiction of Formation) Location of principal office The foreign corporation named below amends its application for its license to transact business in Ohio. (as registered in Jurisdiction of Formation)Certificate of Amendment to Foreign Licensed Corporation Application (For-profit or Nonprofit Foreign Corporation) Filing Fee: $50 (179-FAM) Form Must Be Typed Name of Corporation Assumed Name used in Ohio (if applicable) Complete only the information below that has been amended. Complete the following information (as currently on file in the Ohio Secretary of State's Office).A foreign corporation must file a Certificate of Amendment if, in amending its articles of incorporation, it modifies any of the information included in its application for license to transact business in Ohio or in any amendment to that application. Jurisdiction of Formation Ohio License Number Name of Corporation Assumed Name used in Ohio (if applicable) Jurisdiction of Formation Mailing Address City State ZIP Code Form 565 Prescribed by: For screen readers, follow instructions located at this path. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 4Form 565Last Revised: 06/2019 Location of any Ohio office A brief summary of the corporate purpose(s) to be exercised within the state: Mailing Address City State ZIP Code Print Name By (if applicable) Signature Print Name By (if applicable) Signature Print Name By (if applicable) SignatureBy signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she has the requisite authority to execute this document.Required Must be signed by an authorized officer of the corporation. If authorized representative is an individual, then they must sign in the "signature" box and print their name in the "Print Name" box. If authorized representative is a business entity, not an individual, then please print the business name in the "signature" box, an authorized representative of the business entity must sign in the "By" box and print their name in the "Print Name" box. American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 4Form 565Last Revised: 06/2019Instructions for Certificate of Amendment to Foreign Licensed Corporation ApplicationThis form should be used for a for-profit or nonprofit foreign corporation to file a certificate of amendment. A foreign corporation must file a Certificate of Amendment if, in amending its articles of incorporation in its jurisdiction of formation, it modifies the information included in its application for license to transact business in Ohio or any amendment to that application. Corporation Information Please provide the name of the corporation as registered in its jurisdiction of formation, the assumed name used in Ohio, if applicable, the jurisdiction of formation and the Ohio license number assigned by our office. Amended Information Please provide the new information which will supersede the information currently on file with our office. This may include a change in the corporate name, assumed name, jurisdiction of formation, location of principal office, location of an office in Ohio or the corporate purpose. If the information has not changed, please leave the spot blank on the form. Additional Provisions If the information you wish to provide for the record does not fit on the form, please submit additional provisions on a single-sided, 8 275 x 11 sheet(s) of paper. Signature(s) After completing all information on the filing form, please make sure that page 2 is signed by an authorized officer of the corporation. **Note: Our office cannot file or record a document which contains a social security number or tax identification number. Please do not enter a social security number or tax identification number, in any format, on this form. American LegalNet, Inc. www.FormsWorkFlow.com