Vermont Secretary of State, 128 State Street Montpelier, VT 05633-1104

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 with a self-addressed envelope.

FEE: $25.00   payable to VTSOS