Form Cf-4 - Application For Amended Certificate Of Authority - 2017
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1West Virginia Secretary of State
APPLICATION FOR AMENDED
Business & Licensing Division
CERTIFICATE OF AUTHORITY
Tel: (304)558-8000
Form CF-4
Fax: (304)558-8381
Rev. 11/2017
Website:
FILE ONE ORIGINAL
(Two if you want a filed
stamped copy returned to you)
FEE: $25.00
**** In accordance with the provisions of the West Virginia Code, the undersigned corporation hereby ****
applies for an Amended Certificate of Authority and submits the following statement:
1. Name under which the corporation was
authorized to transact business in WV:
__________________________________________
2. Date Certificate of Authority was issued
__________________________________________
in West Virginia:
3. Corporate name has been changed to:
__________________________________________
(Attach one Certified Copy of Name Change
as filed in home State of incorporation. )
4. Name the corporation elects to use in WV
__________________________________________
due to home State name not being available:
(If name is not available for use in West Virginia, you must attach to this application a Letter of
Resolution signed by the officers or directors of the corporation approving use of a "forced DBA
Name." Download a
sample Letter of
Resolution.)
5. Other amendments:
__________________________________________
(attach additional pages if necessary)
__________________________________________
__________________________________________
6. Name and phone number of contact person. (This is optional, however, if there is a problem with
the filing, listing a contact person and phone number may avoid having to return or reject the
document.)
__________________________________________________ ______________________________
Contact Name
Phone Number
7. Signature information (See below * Important Legal Notice Regarding Signature):
Print Name of Signer: ________________________________ Title/Capacity: __________________
Signature: _________________________________________ Date: ________________________
* Important Legal Notice Regarding Signature: Per West Virginia Code §31D-1-129. Penalty for signing false document.
Any person who signs a document he or she knows is false in any material respect and knows that the document is to be delivered
to the secretary of state for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one
thousand dollars or confined in the county or regional jail not more than one year, or both.
Important Note: This form is a public document. Please do NOT provide any personal identifiable information on this form
such as social security number, bank account numbers, credit card numbers, tax identification or driver’s license numbers.
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