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 Foreign Limited Liability Company)

Under Section 804-A of the Limited Liability Company Law
(for use by agent)

FIRST: The name of the foreign limited liability company is:
Said limited liability company is hereinafter referred to as the "Foreign Limited Liability Company." If applicable: The fictitious name the Foreign Limited Liability Company has agreed to use in New York State is:

SECOND: The jurisdiction of organization of the Foreign Limited Liability Company is: THIRD: The date on which the application for authority was filed by the Department of State
is:

FOURTH: 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 Foreign Limited Liability Company served upon the Secretary of State is changed to:

DOS-1376 (Rev. 5/08)

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"Agent") is the agent of the Foreign Limited Liability Company to whose address the Secretary of State is required to mail copies of process against the Foreign Limited Liability Company served upon the Secretary of State. The post office address previously designated by the Foreign Limited Liability Company for that purpose was the address of the undersigned Agent, and the address specified in paragraph Fourth above is the new address of the undersigned Agent. The undersigned Agent mailed a notice of the proposed change of address to the Foreign Limited Liability Company not less than thirty days prior to the date of delivery of this Certificate to the Department of State. The Foreign Limited Liability Company has not objected to the change of address effected hereby. The undersigned Agent is authorized by Limited Liability Company Law section 804-A(b) to sign and deliver this Certificate.

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

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 Foreign Limited Limited Company)

Under Section 804-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 foreign 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-1376 (Rev. 5/08)

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