Free Fillable Certificate of Amendment Form - New York

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

CERTIFICATE OF AMENDMENT OF
(Insert Name of Foreign Limited Liability Company)

Under Section 804 of the Limited Liability Company Law

FIRST: The name of the limited liability company as it appears on the index of names in
the Department of State is:

If applicable, the fictitious name the foreign limited liability company has agreed to use in this state is:

SECOND: The jurisdiction of organization of the limited liability company is: THIRD: The date on which its application for authority to do business in this state was filed

with the Department of State is:

FOURTH: The application for authority is amended as follows (if the true name of the foreign
(A) Paragraph of the Application for Authority is amended to read as follows:

limited liability company is to be changed, set forth a statement that the change of name has been effected under the laws of the jurisdiction of its formation and the date the change was so effected):

(B) Paragraph

of the Application for Authority is amended to read as follows:

X

(Signature) (Type or print name) (Title of signer)

DOS-1360 (Rev. 5/08)

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CERTIFICATE OF AMENDMENT OF
(Insert Name of Foreign Limited Liability Company)

Under Section 804 of the Limited Liability Company 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 a certificate of amendment for a foreign limited liability company. 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 supply stores. The Department of State recommends that legal documents be prepared under the guidance of an attorney. The certificate must be submitted with a $60 filing fee made payable to the Department of State.
(For office use only)

DOS-1360 (Rev. 5/08)

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