Non-Refundable Processing Fee $37.00
Check Here If:
Foreign Limited Liability Company Foreign Limited Liability Partnership
Foreign Limited PartnershipForeign Limited Liability Limited Partnership
File Number: ________________________
Current Name in Utah: ________________________________________________________________________B
Principal office: ______________________________________________________________________________
1. Amending the business name:
Business entity name in home state: ____________________________________________________________
*The entity shall use as its name in Utah: ________________________________________________________
If the name is not available in Utah the entity shall use: _____________________________________________
*The entity shall use its name as set forth, unless this name is not available.
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 entity in the home state.
[ ] The name of the entity is being changed in Utah to comply with Utah State Insurance Regulations.
2. Amending the jurisdiction of formation
The jurisdiction is changed to: ________________________________________________________________________
3. Purpose of the business:_____________________________________________________________________
4. Amending the Registered Agent
The name of the Registered Agent (Individual or Business Entity or Commercial Registered Agent):
_________________________________________________________________________________________
The address must be listed if you have a non-commercial registered agent. See instructions for further details.
Address of the Registered Agent:
________________________________________________________________
Utah Street Address Required, PO Boxes can be listed after the Street Address
City:
_________________________________________________________ State UT Zip: ________
Under penalties of perjury, I declare this Application to Amend the Certificate of Authority or Registration to be, to the best of
my knowledge and belief, true and correct.
Signature: ___________________________________ Title: __________________________
Date: __________________
Under GRAMA {63G-2-201}, all registration information 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 of Foreign Registration
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
