Free Fillable Certificate of Amendment of Certificate of Assumed Name 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

CERTIFICATE OF AMENDMENT OF CERTIFICATE OF ASSUMED NAME OF
(Insert Name of Entity)

Under Section 130 of the General Business Law

FIRST: The name of the entity is: SECOND: Foreign entities only. If applicable, the fictitious name the entity agreed to use in New York State is:
Certificate of Amendment of Certificate of Assumed Name, the previous name of the entity is:

THIRD: If the name of the entity is different on the last Certificate of Assumed Name or

FOURTH: The entity was formed or authorized under (indicate law):
Business Corporation Law Education Law Insurance Law Limited Liability Company Law Not-for-Profit Corporation Law Revised Limited Partnership Act Other (specify law)

FIFTH: The present assumed name is SIXTH: The date the original Certificate of Assumed Name was filed is:
Assumed Name was filed is:

SEVENTH: The date, if applicable, the last Certificate of Amendment of Certificate of EIGHTH: The following change(s) are being made (check the appropriate change(s)):

Entity Name: The new name of the entity is: Assumed Name: The new assumed name is: Principal Place of Business: The principal place of business is changed to (include the number and street, city, state and zip code) :

DOS-1626 (Rev. 4/08)

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County(ies), Added or Deleted, in Which Business Will be Conducted Under the Assumed Name: County(ies) Added: County(ies) Deleted:

number and street, city, state and zip code):

Address(es) of Specific Business Location(s), Added or Deleted: Business Location(s) Deleted (include the Business Location(s) Added (include the
number and street, city, state and zip code):

INSTRUCTIONS FOR SIGNING: If a corporation, by an officer; if a limited partnership, by a general
partner; if a limited liability company, by a member or manager; or by an authorized person or attorney-infact for such corporation, limited partnership or limited liability company. If the certificate is signed by an attorney-in-fact, include the name and title of the person for whom the attorney-in-fact is acting. (Example, John Smith, attorney-in-fact for Robert Johnson, president.)

Name of Signer

Signature

Title of Signer

CERTIFICATE OF AMENDMENT OF CERTIFICATE OF ASSUMED NAME OF
(Insert Name of Entity)

Under Section 130 of the General Business Law

Filer's Name: Address: City, State and Zip Code:

Note: This form was prepared by the New York State Department of State. 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 all documents be prepared under the guidance of an attorney. The certificate must be submitted with a $25 fee. The Department of State also collects the following, additional, county clerk fees for each county affected by the amendment in which a corporation does or transacts business: $100 for each county within New York City (Bronx, Kings, New York, Queens and Richmond) and $25 for each county outside New York City. All checks over $500 must be certified. For Office Use Only

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