FLORIDA DEPARTMENT OF STATE  
                             DIVISION OF CORPORATIONS 
 
Attached are forms for a change of name, duration, jurisdiction, or purpose for not for profit corporation 
qualified to conduct  its  affairs in Florida as required by section 617.1504, Florida Statutes.   The 
following requirements should be met after the occurrence of such a change within 30 days for a not for 
profit corporation and within 90 days for a profit corporation. NOTE: The purpose can be amended 
only on a not for profit corporation. 
 
 Complete the appropriate application for amendment attached to this letter. 
 
 An original certificate or a document of similar import from the state of incorporation 
  evidencing the amendment must be submitted with the application.  The certificate must be 
  issued within the past 90 days. 
 
 Fees for the amendment are: 
 
  Filing Fee                       $ 35.00 (Includes a letter of acknowledgment) 
  Certified Copy (optional)                                                 $  8.75  
  Certificate of Status (optional) $  8.75  
 
 Send one check in the total amount made payable to the Florida Department of State. 
 
 Please include a letter containing your telephone number, return address and certification 
  requirements, or complete the attached cover letter. 
 
  Mailing Address:                                                                      Street Address: 
  Amendment Section                                                                     Amendment Section 
  Division of Corporations                                                              Division of Corporations 
  P.O. Box 6327                                                                         The Centre of Tallahassee 
  Tallahassee, FL 32314                                                                 2415 N. Monroe Street, Suite 810 
                                                                                        Tallahassee, FL 32303 
 
For further information, you may call (850) 245-6050. 
 
CR2E019 (1/20) 
 

                                                   COVER LETTER 
                                                                  
TO:        Amendment Section 
           Division of Corporations 
 
SUBJECT:                                                                                                                           
                                                   Name of Corporation 
                                                                  
DOCUMENT NUMBER:                                                                                                                   
 
The enclosed Amendment and fee are submitted for filing. 
 
Please return all correspondence concerning this matter to the following: 
 
                         Name of Contact Person 
 
                                  Firm/Company  
 
                               Address  
 
                          City/State and Zip Code 
 
         E-mail address: (to be used for future annual report notification) 
 
For further information concerning this matter, please call: 
 
                                                               at (                 )                                              
              Name of Contact Person                                Area Code & Daytime Telephone Number 
 
Enclosed is a check for the following amount:                                
 
         ☐ $35.00 Filing Fee              ☐ $43.75 Filing Fee &             ☐$43.75 Filing Fee &              ☐$52.50 Filing Fee, 
                                        Certificate of Status                   Certified Copy           Certificate of Status &
                                                                                (Additional copy is      Certified Copy   
                                                                                   enclosed)             (Additional copy is 
                                                                                                            enclosed)  
                                                                  
           Mailing Address:                                                 Street Address: 
           Amendment Section                                                Amendment Section 
           Division of Corporations                                         Division of Corporations 
           P.O. Box 6327                                                    The Centre of Tallahassee 
           Tallahassee, FL 32314                                            2415 N. Monroe Street, Suite 810 
                                                                            Tallahassee, FL 32303 
 

                                 NOT FOR PROFIT CORPORATION 
     APPLICATION BY FOREIGN NOT FOR PROFIT CORPORATION TO FILE 
    AMENDMENT TO APPLICATION FOR CONDUCTING AFFAIRS IN FLORIDA 
                                             (Pursuant to s. 617.1504, F.S.) 
 
                                                                         SECTION I  
                                            (1-3 MUST BE COMPLETED) 
                                                                           
                                           (Document Number of Corporation (If known) 
 
1.                                                                                                                                                  
                                (Name of corporation as it appears on the records of the Department of State) 
 
2.                                                                           3.                                                                     
             (Incorporated under laws of)                                             (Date authorized to conduct affairs in Florida)              
 
                                                                        SECTION II  
                                 (4-8 COMPLETE ONLY THE APPLICABLE CHANGES            ) 
                                                                           
4. If the amendment changes the name of the corporation, when was the change effected under the laws of its 
  jurisdiction of incorporation?                                                              
Note:  If the date inserted in this block does not meet the applicable statutory filing requirements, this date will not be listed as the 
document’s effective date on the Department of State’s records. 
      
5.                                                                                                                                                  
     (Name of corporation after the amendment, adding suffix "corporation," or “incorporated," or appropriate abbreviation, 
     if not contained in new name of the corporation.  “Company,” or “Co.,” may not be used as a corporate suffix by a nonprofit    
     corporation) 
 
6.  If the amendment changes the period of duration, indicate new period of duration and the date the change was 
     effected. 
 
                           (New duration)                                            (Date) 
 
7.  If the amendment changes the jurisdiction of incorporation, indicate new jurisdiction and the date the change         
was effected. 
 
                        (New jurisdiction)                                            (Date) 
 
8.  If the purpose which the corporation intends to pursue in Florida has changed, indicate new purpose. 
                                                                                                                                                    
                  (The corporation is authorized to pursue such purpose in the jurisdiction of its incorporation) 
 
9. Attached is a certificate or document of similar import, evidencing the amendment, authenticated not more than   
  90 days prior to delivery of the application to the Department of State, by the Secretary of State or other official  
  having custody of corporate records in the jurisdiction under the laws of which it is incorporated.  
 
                                (Signature of the chairman or vice chairman of the board, president, or other officer –  
                                               if in the hands of a receiver, trustee, or other court-appointed fiduciary, by that fiduciary) 
 
     (Typed or printed name of the person signing)                                    (Title of person signing)