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
(Name of Domestic Limited Limited Company)

Under Section 211-A of the Limited Liability Company Law
(for use by agent)

FIRST: The name of the limited liability company is:
Said limited liability company is hereinafter referred to as the "Domestic Limited Liability Company." If the name of the Domestic Limited Liability Company has been changed, the name under which the limited liability company was formed is:

SECOND: The date of filing of its articles of organization is: THIRD: The only change effected hereby is: the post office address to which the Secretary of
State shall mail a copy of any process against the Domestic Limited Liability Company served upon the Secretary of State is changed to:

"Agent") is the agent of the Domestic Limited Liability Company to whose address the Secretary of State is required to mail copies of process against the Domestic Limited Liability Company served upon the Secretary of State. The post office address previously designated by the Domestic Limited Liability Company for that purpose was the address of the undersigned Agent, and the address specified in paragraph Third above is the new address of the undersigned Agent. The undersigned Agent mailed a notice of the proposed change of address to the Domestic Limited Liability Company not less than thirty days prior to the date of delivery of this Certificate to the Department of State. The Domestic Limited Liability Company has not objected to the change of address effected hereby. The undersigned Agent is authorized by Limited Liability Company Law section 211-A(b) to sign and deliver this Certificate.

FOURTH: The undersigned person, partnership, or corporation (hereinafter referred to as the

DOS-1375 (Rev. 5/08)

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X

(Signature) (Type or Print Name of "Agent") (If the "Agent" is not a natural person, type or print the name and title of person signing this Certificate on behalf of the "Agent".)

CERTIFICATE OF CHANGE OF
(Name of Domestic Limited Limited Company)

Under Section 211-A of the Limited Liability Company Law

Filed by:

(Name)

(Mailing address)

(City, State and ZIP code)

NOTE: This sample form is provided by the New York State Department of State Division of Corporations for filing a certificate of change to change the address of the agent for service of process of a domestic limited liability company. This form is designed to satisfy the minimum filing requirements pursuant to the Limited Liability Company Law. The Division will accept any other form which complies with the applicable statutory provisions. The Division recommends that this legal document be prepared under the guidance of an attorney. The Division does not provide legal, accounting or tax advice. This certificate must be submitted with a $5 filing fee made payable to the "Department of State."
(For office use only)

DOS-1375 (Rev. 5/08)

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