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State of New Jersey Business Entity Amendment Filing

This form is to amend registration of a business entity with the New Jersey Division of Revenue. The form provided here is simply a sample of what the actual form looks like.

MAIL TO:

PO Box 308
Trenton, NJ 08625

STATE OF NEW JERSEY
DIVISION OF REVENUE

BUSINESS ENTITY AMENDMENT FILING

Fill out all applicable information below and sign in the space provided. Please note that once filed, the information on this page is considered public. Refer to the instructions for delivery/return options, filing fees and field-by-field requirements. Remember to remit the appropriate fee amount for this filing. Use attachments if more space is required for any field, or if you wish to add articles for the public record.

SECTION II - AMENDMENT FILING

A. Business Name: ___________________________________

B. Statutory Authority for Amendment: ___________________________ (See Instructions for List of Statutory Authorities)

C. ARTICLE _______________ OF THE CERTIFICATE of Incorporation ____, Formation ____, Registration ____, Authority ____, Limited Partnership ____, of the above-referenced business is amended to read as follows: (Use attachment if more space is required)

D. Other Provisions: (Optional) ___________________________________

E. Date Amendment was Adopted: ___________________________________

F. CERTIFICATION OF CONSENT/VOTING: (If required by one of the laws cited below, certify consent/voting)

N.J.S.A. 14A:9-1 et seq. or N.J.S.A 15A:9-1 et seq., Profit and Non-Profit Corps. Amendment by the Incorporators

____ Amendment was adopted by unanimous consent of the Incorporators.

N.J.S.A 14A:9-2(4) and 14A:9-4(3), Profit Corps., Amendment by the Shareholders

____ Amendment was adopted by the Directors and thereafter adopted by the shareholders.

Number of shares outstanding at the time the amendment was adopted __________________,

and total number of shares entitled to vote thereon ______________.

If applicable list the designation and number of each class/series of shares entitled to vote: ___________________________________

List votes for and against and if applicable, show the vote by designation and number of each class/series of shares entitled to vote: ___________________________________

Number of Shares Voting for Amendment Number of Shares Voting Against Amendment

** If the amendment provides for the exchange, reclassification, or cancellation of issued shares, attach a statement indicating the manner in which same shall be effected.

N.J.S.A. 15A:9-4, Non-profit Corps., Amendment by Members or Trustees

The corporation has ____ does not have ____ members.

If the corporation has members, indicate the number entitled to vote _______, and how voting was accomplished:

____ At a meeting of the corporation.

Indicate the number VOTING FOR _____ and VOTING AGAINST _____. If any class(es) of members may vote as a class, set forth the number of members in each class, the votes for and against by class, and the number present at the meeting: ____________________________

Class Number of Members Voting for Amendment Voting Against Amendment

____ Adoption was by unanimous written consent without a meeting.

If the corporation does not have members, indicate the total number of Trustees ___________________, and how voting was accomplished:

____ At a meeting of the corporation.

The number of Trustees VOTING FOR ______________ and VOTING AGAINST ______________

____ Adoption was by unanimous written consent without a meeting.

G. AGENT/OFFICE CHANGE

New Registered Agent: ______________________________________________________

Registered Office: (Must be a NJ street address)

Street_________________________________________________

City_______________________

Zip _______________

H. SIGNATURE(S) FOR THE PUBLIC RECORD (See Instructions for Information on Signature Requirements)

Signature _________________________________________________

Title ____________________________________________

Date _____________

Signature _________________________________________________

Title ____________________________________________

Date _____________

The above-signed certifies that the business entity has complied with all applicable NJ statutory filing requirements

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