Application for Amended Certificate

1. Name of Corporation: Name Reservation Number (Optional):

Date business commenced (or proposed to commence) in Georgia:

(Profit Corporations: If the date provided here is more than 30 days prior to the effective date of this application, a $500 penalty must be paid. Penalty is statutory and cannot be waived by Secretary of State. Nonprofit Corporations: There is no late filing penalty.)

2. Name of Filing Person:

Address: City: State: Zip Code:

Filer’s Email Address: Telephone Number:

3. Principal Office Mailing Address: City: State: Zip Code:

4. Name of Registered Agent in Georgia: Registered Agent’s Email Address:

Registered Office Street Address in Georgia:

City: County: State: Zip Code:

5. Corporation’s Name in State or Country of Incorporation:

Jurisdiction (Home State or Country): Date of Incorporation in Home Jurisdiction:

Check ONE: PROFIT NONPROFIT

6. Officer / CEO: Address: City: State: Zip Code:

Officer / CFO: Address: City: State: Zip Code:

Officer / Secretary: Address: City: State: Zip Code:

7. Effective Date: Upon filing Delayed effective date and/or time

A delayed effective date must be within 90 days of the filing date.

8. NOTICE: Mail the following items to the Secretary of State at the above address.

(1) This application;
(2) An ORIGINAL certificate of existence or good standing, not more than 90 days old, certified by the home state or country;
(3) Filing fee of $225.00 payable to “Secretary of State.” Filing fees are non-refundable;
(4) If applicable, a copy of the resolution of the board of directors, certified by corporation’s secretary, adopting a fictitious or trade name.

1. Name of Professional Corporation: Name Reservation Number (Optional):

Date business commenced (or proposed to commence) in Georgia:

If the date provided here is more than 30 days prior the effective date of this application, a $500 penalty must be paid. Penalty is statutory and cannot be waived by Secretary of State.

2. Name of Filing Person:

Address: City: State: Zip Code:

Filer’s Email Address: Telephone Number:

3. Principal Office Mailing Address: City: State: Zip Code:

4. Name of Registered Agent in Georgia: Registered Agent’s Email Address:

Registered Office Street Address in Georgia:

City: County: State: Zip Code:

5. Professional Corporation’s Name in State or Country of Incorporation:

Jurisdiction (Home State or Country): Date of Incorporation in Home Jurisdiction:

6. The purpose of the above-named professional corporation is to practice the profession of:

certified public accountancy professional engineering psychology podiatry

architecture land surveying medicine and surgery veterinary medicine

chiropractic law optometry registered professional nursing

dentistry pharmacy osteopathy harbor piloting

The corporation certifies that it is authorized to pursue such stated purpose in this state and in its state or country of incorporation.

7. Officer / CEO: Address: City: State: Zip Code:

Officer / CFO: Address: City: State: Zip Code:

Officer / Secretary: Address: City: State: Zip Code:

8. Effective Date: Upon filing Delayed effective date and/or time

A delayed effective date must be within 90 days of the filing date.

9. NOTICE: Mail the following items to the Secretary of State at the above address.

(1) This application;
(2) An ORIGINAL certificate of existence or good standing, not more than 90 days old, certified by the home state or country;
(3) Filing fee of $225.00 payable to “Secretary of State.” Filing fees are non-refundable;
(4) If applicable, a copy of the resolution of the board of directors, certified by corporation’s secretary, adopting a fictitious or trade name.

1. Name of Limited Liability Company: Name Reservation Number (Optional):

Date business commenced (or proposed) in Georgia:

If date provided here is more than 30 days prior to the effective date of this application, a $500 penalty plus fees must be paid. Penalty is statutory and cannot be waived by Secretary of State.

2. Name of Filing Person:

Address: City: State: Zip Code:

3. Name of Limited Liability Company in State or Country of Formation:

Jurisdiction (Home State or Country): Date of Formation in Home State or Country: Period of Duration:

4. Address of Principal Place of Business: City: State: Zip Code:

5. Name of Registered Agent in Georgia: Registered Agent’s Email Address:

Registered Office Street Address in Georgia:

City: County: State: Zip Code:

6. Manager’s Name & Address: Address: City: State: Zip Code:

7. Address Where Limited Liability Company’s Records Are Maintained: City: State: Zip Code:

8. Effective Date: Upon filing Delayed effective date and/or time

A delayed effective date must be within 90 days of the filing date.

9. NOTICE: Mail the following items to the Secretary of State at the above address.

(1) This application;
(2) The filing fee of $225.00 payable to “Secretary of State.” Filing fees are non-refundable.

This application is signed by a person duly authorized to sign such instruments by the laws of the jurisdiction under which the foreign limited liability company is organized. The foreign limited liability company undertakes to keep its records at the address shown in #7 above until its registration in Georgia is canceled or withdrawn. The foreign limited liability company, in accordance with Title 14 of the Official Code of Georgia Annotated, appoints the Secretary of State as agent for service of process if no agent has been appointed in Georgia or, if appointed, the agent’s authority has been revoked or the agent cannot be found or served by the exercise of reasonable diligence.