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Application for Amended Certificate of Authority (New Jersey)

This form is to amend the Certificate of Authority of a Foreign Profit or Nonprofit Corporation in New Jersey. The form provided here is simply a sample of what the actual Form C-113a looks like.

New Jersey Department of the Treasury
Division of Revenue

Application for Amended Certificate of Authority

(For Use by Foreign Profit and Nonprofit Corporations)

Check Appropriate Statute:

___ N.J.S.A. 14A:13-6 New Jersey Profit Corporation Act (File in Duplicate)

___ N.J.S.A. 15A:13-6 New Jersey Nonprofit Corporation Act (File in Triplicate)

Pursuant to the provisions of the appropriate Statute, checked above, of the New Jersey Statutes, the undersigned corporation hereby applies for an Amended Certificate of Authority, and for this purpose certifies to the following:

1. Original corporate name: ______________________________

2. New Jersey corporate number: ______________________________

3. New name of corporation (if applicable): __________________________

4. Incorporated under the laws of: ______________________________

The date of foreign incorporation: ______________________________

5. The duration of the corporation is: ______________________________

6. The address of its main office or headquarters is:

______________________________ (Street and postal designation)

______________________________ (City)

______________________________ (State)

______________________________ (Zip)

7. The name and address of its Registered agent in New Jersey is:

______________________________ (Agent's Name)

______________________________ (Street and postal designation)

______________________________ (City)

______________________________ (State)

______________________________ (Zip)

Said Registered Agent is an agent of the corporation upon whom process against the corporation may be served.

8. The business/activities which the corporation is authorized to conduct in New Jersey, and which it is also authorized to conduct in its home jurisdiction are:

______________________________

NOTE: Attach a Good Standing Certificate from the home state dated no more than 30 days prior to filing in New Jersey.

Signature: (Must be Chairperson of the Board, President, or Vice President)

______________________________

Title: ______________________________

Date: ______________________________

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