Request for Amendment

The applicant(s), on behalf of the Company, declare(s):

- to understand that the notary does not perform name searches with the exception of a business name search at the CoC and to indemnify the notary for any and all liabilities or claims related directly or indirectly thereto;

- they are not acting on behalf of third parties and are acting in their own name and for their own risk;

- to have completed this form truthfully and to have read and understood the guidelines of the DEACI regarding changes to licenses.