Business Modification Application

Business Modification Application

WHEREAS, Applicant is duly organized and currently registered to conduct business under the laws applicable to its entity type and maintains a registration on file with the appropriate jurisdictional authority; and

WHEREAS, Applicant seeks to update the public record and corporate registration to reflect changes in name, address, management, ownership, business activity, or other material particulars of the business as set forth in this Application;

Applicant Information

Sole Proprietorship Partnership Corporation Limited Liability Company Other:

Authorized Representative

Modification Requested

Select the specific modification(s) requested and provide the proposed new information or details in the fields below. Attach supporting documents where required.

Change of Business Name — Proposed New Name:

Change of Principal Address — New Address:

Change of Registered Agent — New Agent Name:

Change in Officers / Directors / Managers — Provide details:

Change in Ownership / Membership Interests — Provide details:

Change of Business Activity / NAICS — New Activity:

Change of Fiscal Year End — New Fiscal Year End (Month / Day / Year):

Other Modification — Provide description and rationale:

Month: Day: Year:

Details of Proposed Modification (Scope)

Supporting Documents & Fees

Payment method: Check Credit Card Electronic Transfer

Legal Acknowledgments and Certifications

The Applicant certifies that the information provided in this Application is true, correct, and complete to the best of the Applicant's knowledge. The Applicant acknowledges that knowingly making false statements or omissions in this Application may subject the Applicant to administrative penalties and civil or criminal liability under applicable law.

The Applicant authorizes the processing authority to record, publish, or otherwise effectuate the requested modification in the public record and to request or receive any additional documentation necessary to verify the modification. The Applicant agrees to indemnify and hold harmless the processing authority for actions taken in reasonable reliance on the information contained herein.

Confidentiality: Except as required by law, the processing authority shall treat this Application in accordance with applicable confidentiality obligations. Information required by statute for public record shall be disclosed as required.

Governing Law: This Application and any determination or action taken pursuant to it shall be governed by and construed in accordance with the substantive laws of the jurisdiction under which the original registration was made, without regard to principles of conflicts of law.

Entire Agreement: This Application, together with any supplemental documents submitted in support hereof, constitutes the entire understanding between the Applicant and the processing authority with respect to the requested modifications and supersedes all prior written or oral communications and understandings on this subject.

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