Request For Change Of Registration Information {REG-C-L}

REG-C-L MAILTO: PO BOX 252 STATE OFNEW JERSEY- DIVISION OFREVENUE TRENTON, NJ (6-04) 08646-0252 REQUESTFOR CHANGE OFREGISTRATION INFORMATION NO FEE REQUIRED Use this form to report any change in filing status, business activity, or to change your identification information such as identification number, business and/or trade name, business address, mailing address, etc. DO NOTuse this form for a change in ownership or an incorporation of a business. A NJ-REG must be completed for these changes. A. CURRENT INFORMATION (must be completed to process this form) FEIN ____________________________________________ Name ___________________________________________________________________ ___________________________________________ Address ________________________________________________________________ ____________________________________________B. CHANGES TO IDENTIFICATION INFORMATION FEIN - Reason for change of FEIN ________________________________________ Business Name (Corporations authorized by the NJ State Treasurer must file a corporate name change amendment, pg. 39) Trade Name Business Location: (Do not use P. O.Box for location address) Mailing Name and Address: Street ___________________________________________________ Name ____________________________________________________ Street ____________________________________________________ City ____________________________________ State Zip Code City_______________________________________ State - Zip Code - (Give 9-digit Zip) (Give 9-digit Zip) C. Telephone Numbers: Contact Person ____________________________________________ Title __________________________________ Daytime ( ) __________ - __________________ Evening ( )__________ - __________________ D. IF SEASONAL, CHECK MONTHS BUSINESS WILLBE OPEN: JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC E. CHANGES IN OWNERSHIPOR CORPORATE OFFICERS NAME SOCIALSECURITYNUMBER HOME ADDRESS (Last Name, First, MI) TITLE (Street, City, State, Zip)F. CHANGES IN FILING STATUS AND BUSINESS ACTIVITY Proprietorship/Partnership Date CorporateEntities Business Sold or Discontinued __________________________ Important: Corporate entities may not use this form to dissolve, cancel, withdraw, merge, or consolidate. Forms and Business Incorporated __________________________ Instructions for these changes may be obtained online at www.state.nj.us/njbgs/ or by calling the Division of Revenue Owner Deceased __________________________ at (609) 292-9292. Name and Address of New Owner or Survivor of Merger _____________________________ ________________________________________ Date Ceased Collecting Sales Tax _________________________ Date Ceased Renting Motor Vehicles ___________________ Date Ceased Paying Wages _________________________ Date Ceased Sale of New Tires/Motor Vehicles____________Signature_______________________________________________________Date________________________________________ Title___________________________________________________________Telephone ( ) ___________________________ - 37 - American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2REG-C-EA STATE OFNEW JERSEY Mail to: PO Box 308 (06-04) DIVISION OFREVENUE Trenton, NJ 08625 BUSINESS ENTITYAMENDMENTFILING FEE REQUIREDComplete the following information and sign in the space provided. Plea se note that once filed, the information on this page is considered public.Refer to the instructions for delivery/return options, filing fees and f ield-by-field requirements. Remember to remit the appropriate fee amount for thisfiling. Use attachments if more space is required for any field, or if you wish to add articles for the public record. A. Business Name:__________________________________________________________ _______________________________________________ B. Statutory Authority for Amendment: _______________________________________________ (See Instruc tions for List of Statutory orities)AuthC. ARTICLE __________________ OF THE CERTIFICATE of the above referenced business is amended to read as follows. (If more space isnecessary, use attachment) Check one of the following indicating what type of business: _____Incorporation _____Formation _____Registration ___ _Authority ____Limited Partnership D. Other Provisions: (Optional)_________________________________________ _____________________________________________________ E. Date Amendment was Adopted:____________________ F. CERTIFICATION OF CONSENT/VOTING: (If required by one of the following laws cite d, certify consent/voting) N.J.S.A. 14A:9-1 et seq. or N.J.S.A15A:9-1 et seq., Profit and Non-Profit Corps. Amendment by the Incorporators Amendment was adopted by unanimous consent of the Incorporators. N.J.S.A14A:9-2(4) and 14A:9-4(3), Profit Corps., Amendment by the Shareholders Amendment was adopted by the Directors and thereafter adopted by the sha reholders. Number of shares outstanding at the time the amendment was adopted _____ _____________, and total number of shares entitled to vote thereon ______________. If applicable, list the designation and number of each class/series of shares entitled to vote: List votes for and against amendment, and if applicable, show the vote b y designation and number of each class/series of shares entitled to vote: Number of Shares Voting for Amendment Number of Shares Voting Against Amendment ** If the amendment provides for the exchange, reclassification, or can cellation of issued shares, attach a statement indicating the manner in which same shall be effected. N.J.S.A. 15A:9-4, Non-profit Corps., Amendment by Members or Trustees The corporation has does not have members. If the corporation has members, indicate the number entitled to vote ___ ____, and how voting was accomplished: At a meeting of the corporation. Indicate the number VOTING FOR _____ and VOTING AGAINST_____. If any class(es) of members may vote as a class, set forth the number of members in each class, the votes for and against by class, and the number present at the meeting: Class Number of Members Voting for Amendment Voting Against Amendment Adoption was by unanimous written consent without a meeting. If the corporation does not have members, indicate the total number of Trustees ___________________, and how voting was accomplished: At a meeting of the corporation. The number of Trustees VOTING FOR ______________ and VOTINGAGAINST______________. Adoption was by unanimous written consent without a meeting. G. AGENT/OFFICE CHANGE New Registered Agent: ___