FILING FEE: $200.00
CERTIFICATE OF QUALIFICATION
TO: OKLAHOMA SECRETARY OF STATE
2300 N. Lincoln Blvd., Room 101, State Capitol Building
Oklahoma City, Oklahoma 73105-4897
IF this certificate SOLELY reflects a change of mailing address the fee is $10.00.
The undersigned corporation, for the purpose of amending its Certificate of Qualification pursuant to Title 18,
Section 1131, hereby certifies:
1. A. AS FILED: The name of the corporation is:
B. In the event the corporation was registered in the State of Oklahoma under a fictitious name, the fictitious
C. AS AMENDED: The new name of the corporation is:
D. The change of name has been effected pursuant to the laws of the jurisdiction of its incorporation and the
effective date of the change was the day of , .
2. The jurisdiction of incorporation is:
3. The corporation was duly authorized to do business in the State of Oklahoma on the
day of , .
4. This corporation is organized as: Profit or Not for Profit (Check one)
5. A. The mailing address of the principal office is:
Number Street City County State