Free - West Virginia

Natalie E. Tennant Secretary of State State Capitol Bldg. 1900 Kanawha Blvd. E. Charleston, WV 25305

[email protected] www.wvsos.com

Penney Barker, Manager Corporations Division Tel.(304) 558-8000 Fax (304) 558-8381
Hours 8:30am ­ 5:00pm

FEE $25

WV APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY

File One original application & one certified copy of amendment from incorporation state

In accordance with the provisions of the West Virginia Code, the undersigned corporation hereby applies for an Amended Certificate of Authority and submits the following statement: 1. Name under which corporation was authorized to transact business in WV" Date Certificate of Authority was issued in West Virginia: Corporate name has been changed to:
(attach

2. 3.

one certified copy of name change from home state)

4.
5.

Name the corporation elects to use in WV:
(due to home state name not being available in WV)

Other amendments: (attach additional pages
If necessary)

6. 7. 8. 9. 10.

Date of signing: Print Name of Signer Print Title or Capacity of Signer: Signature of Signer: Contact name and number of person to reach in case of problem with filing: (optional)
Business Email Address, if any:
PRINT THIS COPY, THEN CLICK HERE TO RESET.

11.

Form: CF-4

Issued by the WV Secretary of State, State Capitol, Charleston, WV 25305

Rev. 1/09