APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY The undersigned limited liability company applies for an Amended Certificate of Authority to transact business in the state of______, and for that purpose submits the following statement: 1. A Certificate of Authority was issued to the company by your office on ______[date] authorizing it to transact business in your State and is presently registered under the name of:______. 2. The name of the company has been changed to:_____. 3. The state or country of formation has been changed to:______. 4. It is formed under the laws of:_____. 5. The date of its formation is:______, and the period of its duration is:_____. 6. The address of its principal office in the state or country under the laws of which it is formed is:_____. 7. The mailing address for correspondence and annual report forms:_____. 8. The physical address of its registered office in ____[state] and the name of its registered agent at that address is:_____. The agent must be an individual resident of _____[state], a domestic corporation or not-for-profit domestic corporation or a foreign corporation or not-for-profit foreign corporation authorized to transact business in this state. 9. The name and usual business addresses of its current management: Office Name Address Manager__________________________________________________________ Manager__________________________________________________________ Manager__________________________________________________________ 10. An estimate, expressed in dollars, of the value of the property of the company located and employed in the state of Wyoming: $_________. 11. The corporation accepts the Constitution of the state of Wyoming in compliance with the requirements of Article 10, Section 5, of the Wyoming Constitution. By________________________ Title_____________________ [may be executed by a listed manager] For name availability purposes list the type of business the company will be conducting:________.