Free Fillable Certificate of Change 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 CHANGE OF
(Insert Name of Foreign Limited Liability Company)

Under Section 804-A of the Limited Liability Company Law

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

SECOND: The application for authority was filed with the Department of State on:

THIRD: The change(s) effected hereby are: [Check appropriate statement(s)]
The county location, within this state, in which the office of the foreign limited liability company is located, is changed to: The address to which the Secretary of State shall forward copies of process accepted on behalf of the foreign limited liability company is changed to read in its entirety as follows:

The foreign limited liability company hereby: [check one] Designates as its registered agent upon whom process against the foreign limited liability company may be served. The street address of the registered agent is: Changes the designation of its registered agent to: The street address of the registered agent is: Changes the address of its registered agent to: Revokes the authority of its registered agent. .

X

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

DOS-1362 (Rev. 5/08)

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

Under Section 804-A 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 change by a foreign limited liability company. 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 $30 filing fee made payable to the Department of State.
(For office use only)

DOS-1362 (Rev. 5/08)

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