Application For Amended Certificate Of Authority {L-10}

BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form L-10) Instructions for Filing APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY OF LIMITED LIABILITY COMPANY (Form L-10) Item 1 Limited Liability Company Name (a) Enter the complete name of the limited liability company exactly as it appears of record on the current North Carolina Certificate of Authority. (b) A fictitious name to be used in North Carolina is required if the original name on the Certificate of Authority is not available for use in North Carolina. If a fictitious name is being used, enter the fictitious name of record with the North Carolina Department of the Secretary of State. Item 2 Enter the state or country of formation. Item 3 Enter the date the limited liability company was authorized to transact business in North Carolina. Item 4 Enter the changes being made to the information contained in the previous Certificate of Authority. This document is to be used for the following changes only: (a) Any changes to the name of the company; and (b) A change to the jurisdiction of its organization. Item 5 A current (within six (6) months) Certificate of Existence from the state or country of formation is required with this filing. Item 6 The document will be effective on the date and at the time of filing, unless a delayed date or an effective time (on the day of filing) is specified. If a delayed effective date is specified without a time, the document will be effective at 11:59:59 p.m. Raleigh, North Carolina time on the day specified. If a delayed effective date is specified with a time, the document will be effective on the day and at the time specified. A delayed effective date may be specified up to and including the 90th day after the day of filing. Date and Execution Enter the date the document was executed. In the blanks provided enter: The name of the limited liability company as it appears in item 1. The signature of the company official of the limited liability company executing the document. The name and title of the above-signed company official. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form L-10) State of North Carolina Department of the Secretary of State APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY FOR LIMITED LIABILITY COMPANY Pursuant to 24757D-7-04 of the General Statutes of North Carolina, the undersigned limited liability company hereby applies for an Amended Certificate of Authority to transact business in the State of North Carolina, and for that purpose submits the following statement. 1. Name of Limited Liability Company a. The name of the limited liability company exactly as it appears on the Certificate of Authority currently on file with the North Carolina Department of the Secretary of State: b. The fictitious name, if any, of the limited liability company currently on file with the NC Department of the Secretary of State is: 2. The state or country of formation is: 3. The date the limited liability company was authorized to transact business in the State of North Carolina is: . 4. The changes being made are as follows: (See instructions for the specific uses of this document.) 5. Attached is a certificate of existence (or document of similar import), duly authenticated by the Secretary of State or other official having custody of limited liability company records in the state or country of formation. The certificate of existence must be less than six months old. A photocopy of the certification cannot be accepted. 6. This application will be effective upon filing, unless a date and/or time is specified:. This the day of , 20 . Name of Limited Liability Company Signature Type or Print Name and Title Notes: 1. Filing fee is $50. This application must be filed with the Secretary of State. American LegalNet, Inc. www.FormsWorkFlow.com