L-102 NJSA 42 (2/94)
New Jersey Division of Revenue
Certificate of Amendment
Limited Liability Company
This form may be used to amend a Certificate of Formation of a Limited Liability Company on file with the
Department of the Treasury. Applicants must insure strict compliance with NJSA 42, the New Jersey Limited
Liability Act, and insure that all applicable filing requirements are met.
1. Name of Limited Liability Company:
2. Identification Number:
3. New LLC Name (if applicable):
4. Effective Date:
5. The Certificate of Formation is amended as follows (provide attachments if needed):
The undersigned represent(s) that this filing complies with State law as detailed in NJSA 42 and that they are
authorized to sign this form behalf of the Limited Liability Company.
Signature:
Name:
Date:
NJ Division of Revenue, PO Box 308, Trenton, NJ 08646
