Fill and Sign the pdfFiller Fillable Online Application for Amended Certificate of Form

Secretary of State OFFICE OF SECRETARY OF STATE CORPOR A TIONS DIVISION 2 Martin Luther King Jr. Dr. SE Suite 313 West Tower Atlanta, Georgia 30334 (404) 656 - 2817 sos.georgia.gov/corporations APPLIC ATIO N FO R CERTIFIC AT E O F AUTHORITY FO R FOREIG N PROFIT OR NONPROFIT CORPO R ATION IMPORTANT : P lease p rovide t h e en ti t y’ s pr ima r y e mail address w hen completing this form. Primary Em ail Address : NOTICE TO APPLICANT: PRINT PLAINLY OR TYPE REMAINDER OF THIS FORM 1. Name of Corporation Name Reservation Number (Optional) Date business commenced (or proposed to commence ) in Georgia: ( NOTE: (1) Profit Corporations: I f the date provided here is more than 30 da y s prior to the effective date of t h is application, a $500 penalty must be paid . P enalty is statutory and cannot be w aived by Secretary of Sta t e. (2) Nonprofit Corporations: There is no late filing penalty. ) 2. Name of F iling P erson Address City State Zip Code Filer’s Email Address Telephone Number 3. Principal Office Mailing Address (may be P.O. Box) City State Zip Code 4. Name of Registered Agent in Georgia Registered Agent’s Email Address Registered Office Street Address in Georgia ( p ost office box or mail drop not acceptable for registered office address) GA City County State Zip Code 5. Corporation’s Name in State or Country of Incorporation ( Must match name on certificate of existence) Check ONE : Jurisdiction ( Home State o r Country): Date of Incorporation in Home Jurisdiction: PROFIT NONPROFIT 6. Officer / CEO Address City State Zip Code Officer / CFO Address City State Zip Code Officer / S ecretary Address City State Zip Code 7. Effective Date: (Choose one) 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 . ( Certificate from home state may not be more than 90 days old ; c opy of articles of incorporation from home state should NOT be submitted . ) ; and (3) Filing fee of $225.00 pa y able to “Secretary of State.” F iling 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. Signature of Authorized Person Date Print name Title FORM 236 (Rev . 10/2018 )