Application for Amended Certificate of Authority (Tennessee)
This is an application for an amended certificate of authority for a nonprofit corporation in Tennessee. The form provided here is simply a sample of what the actual Form SS 4434 looks like.
For Office Use Only
APPLICATION FOR AMENDED
CERTIFICATE OF AUTHORITY
(NONPROFIT)
Corporate Filings
312 Eighth Avenue North
6th Floor, William R. Snodgrass Tower
Nashville, TN 37243
Pursuant to the provisions of Section 48-65-104 of the Tennessee Nonprofit Corporation Act, the undersigned corporation hereby applies for an amended certificate of authority to transact business or conduct affairs in the State of Tennessee, and for that purpose sets forth:
1. The name of the corporation is ______________________
If different, the name under which the certificate of authority is to be obtained is
______________________
2. The state or country under whose law it is incorporated is
______________________
3. The date of its incorporation is ______________________ (must be month, day, and year), and the period of duration, if other than perpetual, is
______________________
4. The complete street address (including zip code) of its principal office is
Street ______________________
City ______________________
State ______________________
Zip Code ______________________
5. The complete street address (including the county and the zip code) of its registered office in Tennessee is
Street ______________________
City ______________________
State/Country ______________________
Zip Code ______________________
Registered agent ______________________
6. The names and complete business addresses (including zip code) of its current officers are: (Attach separate sheet if necessary.)
Name ______________________
Street ______________________
City ______________________
State ______________________
Zip Code ______________________
Name ______________________
Street ______________________
City ______________________
State ______________________
Zip Code ______________________
7. The names and complete business addresses (including zip code) of its current board of directors are: (Attach separate sheet if necessary.)
Name ______________________
Street ______________________
City ______________________
State ______________________
Zip Code ______________________
Name ______________________
Street ______________________
City ______________________
State ______________________
Zip Code ______________________
8. ____ The corporation has members.
____ The corporation has no members.
[NOTE: Please mark the applicable box in #8.]
9. The corporation is a nonprofit corporation.
10. If the corporation had been incorporated in Tennessee, it would be
____ a public benefit corporation, or
____ a mutual benefit corporation.
[NOTE: Please mark the applicable box in #10.]
11. If the document is not to be effective upon filing by the Secretary of State, the delayed effective date/time is
______________________, ______________________ (date) ______________________ (time).
[NOTE: A delayed effective date shall not be later than the 90th day after the date this document is filed by the Secretary of State.]
[NOTE: This application must be accompanied by a certificate of existence (or a document of similar import) duly authenticated by the Secretary of State or other official having custody of corporate records in the state or country under whose law it is incorporated. The certificate shall not bear a date of more than two (2) months prior to the date the application is successfully filed in Tennessee.]
Signature Date ______________________
Name of Corporation ______________________
Signer's Capacity ______________________
Signature ______________________
Name ______________________ (typed or printed)