Free Fillable Foreign Professional Service Application for Authority Form - New York

New York State Department of State Division of Corporations, State Records & Uniform Commercial Code One Commerce Plaza, 99 Washington Avenue Albany, NY 12231 www.dos.state.ny.us

APPLICATION FOR AUTHORITY OF
(Insert name of Foreign Professional Service Corporation)

Under Section 1530 of the Business Corporation Law

FIRST: The name of the foreign professional service corporation is:
If the name does not contain the required words or abbreviation pursuant to Section 1530(a)(1) of the Business Corporation Law, the following words or abbreviation is added to the name for its use in this State: (Do not complete this section unless the corporation's true name is not available for use in this state pursuant to §301 and §302 Business Corporation Law.) The fictitious name the foreign professional service corporation agrees to use in New York State is:

SECOND:

(A certificate of existence by an authorized officer of the jurisdiction of its incorporation must be attached to this application. ) The jurisdiction of incorporation of the foreign professional service

corporation is:

The date of its incorporation is:

THIRD: The foreign professional service corporation shall practice the profession(s) of
in the State of New York.

FOURTH: The foreign professional service corporation is authorized to practice such profession(s) in the jurisdiction of its incorporation.

address and license number of each person within the foreign professional service corporation who is licensed to practice the profession(s) in this state are:

FIFTH: (Attach the appropriate certificate(s) from the New York State licensing authority.) The name,

office is to be located is: A county in New York State must be stated. (Please note that the corporation is not required to have an actual physical office in this state.)

SIXTH: The city, incorporated village or town and the county within this state in which its

DOS-1627 (Rev. 5/08)

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SEVENTH: The Secretary of State is designated as agent of the foreign professional service corporation upon whom process against it may be served. The address within or without this state to which the Secretary of State shall mail a copy of any process served against him or her is:

EIGHTH: (Check the statement that applies.)
The foreign professional service corporation has not since its incorporation or since the date its authority to do business in New York State was last surrendered, engaged in any activity in this State. The consent of the State Tax Commission is attached.

(Signature)

(Signer's Title)

(Signer's Name)

APPLICATION FOR AUTHORITY OF
(Insert name of Foreign Professional Service Corporation)

Under Section 1530 of the Business Corporation Law

Filed by:

(Name) (Mailing address) (City, State and Zip Code)

Note: This form was prepared by the New York State Department of State for filing an application for authority by a foreign professional service corporation. It does not contain all optional provisions under the law. You are not required to use this form. You may draft your own form or use forms available at legal stationery stores. The Department of State recommends that legal documents be prepared under the guidance of an attorney. The certificate must be submitted with a $200 filing fee made payable to the Department of State. (For Office Use Only)

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