Non-Refundable Processing Fee $37.00
File Number: _________________________
Current Name in Utah: ________________________________________________________________________
Principal Office:______________________________________________________________________________
1. Amending the business name:
Name of Home State: _______________________________________________________________________
Business entity name in home state: ____________________________________________________________
*The entity shall use as its name in Utah: ________________________________________________________
If the name is not available in Utah the corporation shall use _________________________________________
*The entity shall use its name as set forth, unless this name is not available.
If the business name has changed its name in the home state, a certified copy of the amendment or a Certificate of
Fact name change must accompany this application.
Check either or both of the following which apply:
[ ] The name of the entity is changing its name in Utah to the new name of the corporation in the home state.
[ ] The name of the entity is being changed in Utah to comply with Utah State Insurance Regulations.
2. Amending the duration of the business existence
The businesses period of duration is changed to: _________________________________________________
3. Purpose of the business: ____________________________________________________________________
4. Amending the state or country of incorporation
The entity's state or country of incorporation is changed to: __________________________________________
Under penalties of perjury, I declare this Amendment to Authority to Conduct Affairs for a Foreign Corporation
to be, to the best of my knowledge and belief, true and correct.
Signature: ___________________________________ Title: __________________________
Date: __________________
Under GRAMA {63G-2-201}, all registration informa
tion maintained by the Division is classified as public record. For confidentiality purposes, you
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
State of Utah
Department of Commerce
Division of Corporations & Commercial Code
Amendment to Authority to Conduct Affairs for a Foreign Corporation
This form must be type written or computer generated.
Sign here after the form is printed
Mailing/Faxing Information:
www.corporations.utah.gov/contactus.html
www.corporations.utah.gov
