Fill - Free fillable Amendment or Correction to Biennial Report (Nebraska) PDF form

Amendment or Correction to

Biennial Report

Robert B. Evnen, Secretary of State

P.O. Box 94608

Lincoln, NE 68509

(402) 471-4079

1) Exact Name of Corporation (exact name as stated in articles of incorporation or certificate of authority filed with the

Nebraska Secretary of State)

__________

_______________________________________________________________________________

2) Amendment or Correction applies to the following type of Biennial Report (check only one box):

 Foreign Corporation Domestic Corporation

3) Years of Biennial Report being corrected (found on Report form):_______________-______________

(note you must file a separate form for each reporting period being corrected)

4) Amendment or Correction is correcting or adding names of (check boxes as applicable):

 Officer and indicate title of office and/or  Director (attach additional page if necessary)

_______________________________________________________________________________

(Indicate whether change or addition is Officer (give title) or Director and provide both name and address of same)

 ______________________________________________________________________________

(Indicate whether change or addition is Officer (give title) or Director and provide both name and address of same)

5) Amendment or Correction is correcting Principal Office:

________________________________________________________________________________________

Street Address City State Zip

6) Amendment or Correction is correcting name of state or jurisdiction under whose laws the corporation is

formed

: _____________________________________________

7) Amendment or Correction is correcting Nature of Business conducted in Nebraska: _______________

__________

___________________________________________________________________________

8) Amendment or Correction is changing Location of Property Owned or Used in Nebraska: __________

_______

______________________________________________________________________________

Amendment or Correction is changing the Actual Value of Real Estate and Personal Property in Nebraska (if

Foreign Corporation only)

: from $ ________________ to $________________. (Enclose additional occupation tax

due for Corporation or if refund is due contact Secretary of State for refund form. Attach explanation of increase or

decrease in Actual Value of Real Estate or Personal Property.)

 Amendment or Correction is changing the Amount of Paid Up Capital Stock (if Domestic Corporation only):

from $ ________________ to $ ________________. (Enclose additional occupation tax due for Corporation or if

refund is due, contact Secretary of State for refund form. Attach explanation of increase or decrease in Amount of

Paid Up Capital Stock.)

_____________________________________________________________________

Signature

FILING FEES: $30.00 (plus $5.00 for any additional pages).

Make check payable to: Secretary of State.

Revised 01/10/2019

Neb. Rev. Stat. § 21-301, 21-304

INS

TRUCTIONS FOR COMPLETING

AMENDMENT OR CORRECTION TO BIENNIAL REPORT FORM

1. Name--Please state the exact name of the Foreign Corporation or Domestic Corporation, as it appears

in the Articles of Incorporation or Certificate of Authority filed with the Nebraska Secretary of State.

2. Type of Biennial Report being amended or corrected: Select the check box which corresponds to the

type of Biennial Report this Amendment or Correction refers to either Foreign or Domestic Corporation.

3. Reporting period-The amending party is required to submit a separate Amendment or Correction form

for each prior biennial report being corrected or amended and pay applicable fee for each form to be filed

(see below).

4. Officer or Director changes or additions: For a change or addition to an Officer, you must provide

officer’s name and the title of the office (example: President) and complete address. For Director changes

or additions, provide the name of the director and complete address.

5. Address of Principal Office: Please provide the complete address if amending or correcting the

Principal Office.

6. Correction to Name of State or Jurisdiction: Please provide the name of the state or jurisdiction under

whose laws it was originally filed.

7. Nature of Business: State the amended or corrected nature of business conducted in Nebraska.

8. Location of Property Owned or Used in Nebraska: State the amended or corrected location of property

owned or used in Nebraska.

9. Actual Value of Real Estate and Personal Property in Nebraska (if Foreign Corporation) OR Amount

of Paid Up Capital Stock (if Domestic Corporation): Select the applicable check box for the type of

corporation. Provide the original dollar amount reported on the Biennial Report being amended or

corrected and the corrected dollar amount. (Enclose additional occupation tax due for reporting period or

if refund is due, contact Secretary of State for refund form to submit with this Amendment or Correction.

Attach explanation of increase or decrease in Actual Value of Real Estate or Personal Property (if Foreign

Corporation) or Amount of Paid Up Capital Stock (if Domestic Corporation).

10. Signature of person completing the Amendment or Correction to Biennial Report

Filing fee is $30.00 (plus $5.00 per page for any additional pages)

Make check payable to: Secretary of State.

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