APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY 
(profit or non-profit T.11A-B, §15.04)

Name as qualified in Vermont:

A corporation created and existing under the laws of the state (country) of:  

Date of incorporation: Duration (if not purpetual):  

NAME OF REGISTERED AGENT: 
Registered office address:      
City   VERMONT  Zip Code
Principal Office Address:
City  
State Zip Code

OFFICERS / DIRECTORS NAMES AND ADDRESSES:  

Pres  Add
V.P. 
  Add
Sec     Add
Trea   Add    
Dir   
    Add
Dir      Add  

The corporate name is changed to:

State of Incorporation is changed to:Duration is changed to:

Signature__________________________________________Title________________Date___________

A certificate of good standing (dated no earlier than 30 days prior to filing) MUST be attached from the state of origin.   Please file in duplicate.

FEE: $25.00