Application For Amended Certificate Of Authority Professional Limited Liability Company {PLLC-03}

BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626 - 0622 (Revised August 2017) (Form PLLC - 03) Instructions for Filing APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY (PROFESSIONAL LIMITED LIABILITY COMPANY) (Form PLLC - 03) Item 1 Enter the complete name of the limited liability company exactly as it appears on the current Certificate of Authority. Item 2 Enter the limited liability company name used in North Carolina exactly as it appears on the current Certificate of Authority. Item 3 Enter the state or country of organization. Item 4 Enter the date the limited liability comp an y was a uthorized to transact business in North Carolina. Item 5 Enter the personal services to be rendered by the limited liability company in North Carolina. Item 6 Enter the name of at least one Company Official of the limited liability company who is a licen see of the licensing board which regulates the practice of each professional service to be rendered in North Carolina. Item 7 See form. Item 8 Enter the changes being made to the information contained in the previous Certificate of Authority. If the nam e of the limited liability company as changed is unavailable for use in North Carolina, indicate this fact and state the name the limited liability company wishes to use in North Carolina on 8b. (See N.C.G.S. 247 55D - 22) Item 9 See form. Item 10 See form. Item 11 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 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 90 t h day after the day of filing. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626 - 0622 (Revised August 2017) (Form PLLC - 03) State of North Carolina Department of the Secretary of State APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY (PROFESSIONAL LIMITED LIABILITY COMPANY) Pursuant to 247 57D - 7 - 04 and Chapter 55B of the General Statutes of Nort h 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. The name of the limited liability compa ny is: 2. The name the limited liability company is using in the State of North Carolina is: 3. The state or country of organiz ation is: 4. The date the limited liability company was authorized to transact business in the State of North Carolina is: 5. The personal services to be rendered by the limited liability company are: 6. With respect to each professional service practiced or to be practiced through the limited liability company in this State, the name of at least one of the limited liabil Company Officials who is a licensee of the licensing board which regulates such profession in this State is: ( insert name here ) 7. Attached are certification s by the appropriate licensing boards that each person set forth in Item 6 above - 2(2). 8. This application is filed for the following reason (complete all applicable items) : a. The limited liability company has c hanged its corporate name to : b. The name the limited liability company will hereafter use in the State of North Carolina is changed to: American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626 - 0622 (Revised August 2017) (Form PLLC - 03) Application for Amended Certificate of Authority (Professional Limited Liability Company) Page 2 c . The limited liability company has changed the state or country of its organization to: d . (Other) 9. Attached is a certificate setting forth and attesting to the change, duly authenticated by the secretary of state or other official having custody of limited liability company records in the state or country of organization. 10. If the limited liability company is required to use a fictitious name in order to transact business in this State, a copy of the resolution of its managers adopting the fictitious name is attached. 11. This application will be effective upon filing, unless a date and/or time not later than 90 days after the date of filing is specified: . This the day of , 20 . By executing this application on behalf of the applicant limited liability company, I certify under oath that the undersigned limited scope of N.C.G.S. Sections 57 D - 2 - 0 2 and 55B - 16(b). Name of Limited Liability Company Signature of Company Official Type or Print Name and Title American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626 - 0622 (Revised August 2017) (Form PLLC - 03) Application for Amended Certificate of Authority (Professional Limited Liability Company) Page 3 (State document is signed in) (County document is signed in) This day of , 20, personally came before me, , (Notary Public) Notary Public, , who, being by me duly sworn, says that he/she is (Name of Company Official) of , a professional limited liability (Title of Company Official) (Name of P LLC) company, and that this Application for Amended Certificate of Authority was signed by him/her on behalf of the professional limited liability company by its authority duly given. And the said ( Name of Company Offic i al) acknowledged the said writing to be the act and deed of said professional limited liability company. Witness my hand and official seal, this the day of , 20. (Official Seal) Notary Public My Commission Expires , 20 . NOTES: 1. Filing fee is $50. This application must be filed with the Secretary of State. 2. application. To determine whether a particular limited N.C.G.S. Sections 57 D - 2 - 02 and 55B - 16(b). If the company does not meet tho se requirements, it must use the standard form for a limited liability company. American LegalNet, Inc. www.FormsWorkFlow.com