State of Vermont

---

Office of the Secretary of State

---

The form below can be printed out by hitting "Print" on your web browser. Web pages tend to print out in a long format; therefore, a more compact version of this form can be saved and printed out in the following standard word processor formats:
• fcamend.doc -- DOC -- Microsoft Windows, Word, WordPad format
• fcamend.wpd -- WPD -- WordPerfect Document format
• fcamend.rtf -- RTF -- Rich Text Format
• fcamend.txt -- TXT -- simple text format

---

APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY
(profit or non-profit)

________________________________________________________________
(full name of corporation as qualified in Vermont)

A corporation created and existing under the laws of the state (country) of
__________________

Date of incorporation_____________________________Duration_______________________

Principal office:_________________________________________________________________
(street) (city) (state) (zip)

Name of registered agent inVermont_______________________________________________

Registered office inVermont
___________________________________________
___________________________________________Vermont_____________
(street; not P.O. Box) (city) (zip)

Name and business addresses of current directors and officers.

President____________________Address__________________________________________________

V.President__________________Address__________________________________________________

Secretary____________________Address__________________________________________________

Treasurer____________________Address__________________________________________________

Director_____________________Address__________________________________________________

Director_____________________Address__________________________________________________

Director_____________________Address__________________________________________________
(if additional space is needed you may attach a list or use the reverse side of this application)

Its name is changed to:____________________________________________________________

Its duration has been changed to:__________________________________________________

Its state of incorporation has been changed to:____________________________________

Signature__________________________Title________________Date___________

FEE: $25.00

A CERTIFICATE OF GOOD STANDING, (DATED NO EARLIER THAN 30 DAYS PRIOR TO FILING) MUST BE ATTACHED FROM THE STATE OF ORIGIN. THIS DOCUMENT MUST BE TYPEWRITTEN OR PRINTED AND FILED IN DUPLICATE. TO EXPEDITE RECEIPT OF YOUR COPY SEND A SELF-ADDRESSED, STAMPED ENVELOPE.