Toll Free: (877) SOS-FILE (877-767-3453)  |  Central Ohio: (614) 466-3910  
                                   www.OhioSecretaryofState.gov  |  Busserv@OhioSecretaryofState.gov 
                                   File online or for more information: www.OHBusinessCentral.com

                                   Filing Form Cover Letter

Please return the approval certificate to:

Name (Individual or Business Name):

To the Attention of (if necessary):

Address:

City:

State                                                                    ZIP Code:

Phone Number:                             E-mail Address:

         Check here if you would like to receive important notices via e-mail from the Ohio Secretary of State's office regarding 
         Business Services.

         Check here if you would like to be signed up for our Filing Notification System for the business entity being created or 
         updated by filing this form. This is a free service provided to notify you via e-mail when any document is filed on your 
         business record.

Please make checks or money orders payable to: "Ohio Secretary of State" 
Type of Service Being Requested:  (PLEASE CHECK ONE BOX BELOW)

Regular Service: Only the filing fee listed on page one of the form is required and the filing will be 
processed in approximately 3-7 business days.  The processing time may vary based on the volume of 
filings received by our office.

Expedite Service 1:  By including an Expedite fee of $100.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 2 business days after it is received by our office. 

Expedite Service 2:  By including an Expedite fee of $200.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 1 business day after it is received by our office. This 
service is only available to walk-in customers who hand deliver the document to the Client Service Center.

Expedite Service 3:  By including an Expedite fee of $300.00, in addition to the regular filing fee on page 
one of the form, the filing will be processed within 4 hours after it is received by our office, if received by 1:00 
p.m.  This service is only available to walk-in customers who hand deliver the document to the Client Service Center.

Preclearance Filing:  A filing form, to be submitted at a later date for processing, may be submitted to be 
examined for the purpose of advising as to the acceptability of the proposed filing for a fee of $50.00. The 
Preclearance will be complete within 1-2 business days.

Form 565                                  Page 1 of 4                    Last Revised: 10/01/2017

Form 565 Prescribed by:
                                                                                                            Mail this form to one of the following: 
                                             Toll Free: (877) SOS-FILE (877-767-3453) 
                                                                                                            Regular Filing (non expedite) 
                                             Central Ohio: (614) 466-3910                                   P.O. Box 1329 
                                                                                                            Columbus, OH  43216 
                                             www.OhioSecretaryofState.gov 
                                                                                                            Expedite Filing (Two business day processing time. 
                                             Busserv@OhioSecretaryofState.gov                                                         Requires an additional $100.00) 
                                                                                                            P.O. Box 1390 
                                             File online or for more information: www.OHBusinessCentral.com Columbus, OH  43216
For screen readers, follow instructions located at this path.

  Certificate of Amendment to Foreign Licensed Corporation Application 
                            (For-profit or Nonprofit Foreign Corporation) 
                                                             Filing Fee: $50 
                                                             (179-FAM)             
                                                             Form Must Be Typed 
A foreign corporation must file a Certificate of Amendment if, in amending its articles of incorporation, it modifies any 
of the information included in its application for license to transact business in Ohio or in any amendment to that 
application.
  Complete the following information (as currently on file in the Ohio Secretary of State's Office).
  
The foreign corporation named below amends its application for its license to transact business in Ohio. 
  
  Name of Corporation
  
(as registered in Jurisdiction of Formation)

Assumed Name used in Ohio (if applicable)

Jurisdiction of Formation

Ohio License Number

   Complete only the information below that has been amended.  
  
The information provided below supersedes the information currently on file with the Ohio Secretary of 
State's Office. 
  
  Name of Corporation
  
(as registered in Jurisdiction of Formation) 
  
  Assumed Name used in Ohio (if applicable)
  
  Jurisdiction of Formation
  
Location of principal office

  Mailing Address

  City                                                                                State                                           ZIP Code

Form 565                                                     Page 2 of 4                                    Last Revised: 10/01/2017

Location of any Ohio office 

   Mailing Address
  
                                                       OH
   City                                                State                 ZIP Code
  
A brief summary of the corporate purpose(s) to be exercised within the state:

  By signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she 
  has the requisite authority to execute this document.

  Required      
    
  Must be signed by an          Signature
  authorized officer of the 
  corporation. 
                                By (if applicable)
  If authorized representative 
  is an individual, then they 
  must sign in the "signature" 
  box and print their name      Print Name
  in the "Print Name" box. 
   
  If authorized representative 
  is a business entity, not an 
  individual, then please print 
  the business name in the      Signature
  "signature" box, an 
  authorized representative 
  of the business entity        By (if applicable)
  must sign in the "By" box 
  and print their name in the 
  "Print Name" box. 
                                Print Name

                                Signature

                                By (if applicable)

                                Print Name

Form 565                                  Page 3 of 4                        Last Revised: 10/01/2017

         Instructions for Certificate of Amendment to Foreign Licensed 
                        Corporation Application

This form should be used for a for-profit or nonprofit foreign corporation to file a certificate of 
amendment. A foreign corporation must file a Certificate of Amendment if, in amending its articles of 
incorporation in its jurisdiction of formation, it modifies the information included in its application for 
license to transact business in Ohio or any amendment to that application. 
  
Corporation Information 
Please provide the name of the corporation as registered in its jurisdiction of formation, the assumed 
name used in Ohio, if applicable, the jurisdiction of formation and the Ohio license number assigned 
by our office.  
  
Amended Information 
Please provide the new information which will supersede the information currently on file with our 
office. This may include a change in the corporate name, assumed name, jurisdiction of formation, 
location of principal office, location of an office in Ohio or the corporate purpose. If the information 
has not changed, please leave the spot blank on the form.  
  
Additional Provisions 
If the information you wish to provide for the record does not fit on the form, please submit additional 
provisions on a single-sided, 8 ½ x 11 sheet(s) of paper.  
  
Signature(s) 
After completing all information on the filing form, please make sure that page 2 is signed by an 
authorized officer of the corporation.  
  
**Note:  Our office cannot file or record a document which contains a social security number 
or tax identification number. Please do not enter a social security number or tax identification 
number, in any format, on this form. 
  
Form 565                                Page 4 of 4                        Last Revised: 10/01/2017