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Amendment to Annual Report (Oregon)

This amends a business annual report in Oregon. The form provided here is simply a sample of what the actual Form CR139 looks like.

CR139

Phone: (503) 986-2200
Fax: (503) 378-4381
Secretary of State
Corporation Division
255 Capitol St. NE, Suite 151
Salem, OR 97310-1327

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For office use only

____ Professional Corporation

____ Nonprofit Corporation

____ Business Corporation

____ Cooperative

____ Water District

Registry Number: ________________________________

Entity Type ____ DOMESTIC ____ FOREIGN

Please Type or Print Legibly in Black Ink - NO Filing Fee

To change the Registered Agent, use Change of Registered Agent/Address, Form CR131

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Amendment to Annual Report

1) Name of Entity __________________________________

2) Principal Place of Business (street address)

Address __________________________________

City __________________________________

State __________________________________

Zip __________________________________

3) Mailing Address

Address __________________________________

City __________________________________

State __________________________________

Zip __________________________________

4) President (Name and street address)

Name __________________________________

Address __________________________________

City __________________________________

State __________________________________

Zip __________________________________

5) Secretary (Name and street address)

Name __________________________________

Address __________________________________

City __________________________________

State __________________________________

Zip __________________________________

6) Execution

Signature ____________________________________

Printed Name ____________________________________

Title ____________________________________

Date __________________________________

7) Contact Name ____________________________________

Daytime Phone Number--Including Area Code _______________________

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