Free Fillable Certificate of Resignation of Registered Agent 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 RESIGNATION OF REGISTERED AGENT OF
(Insert Name of Foreign Limited Liability Company)

Under Section 302(d) of the Limited Liability Company Law

FIRST: The name of the foreign 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 date on which its application for authority to do business in this state was
filed with the Department of State is:

THIRD: The jurisdiction of organization of the limited liability company is: FOURTH: The registered agent hereby resigns. FIFTH: [check appropriate statement]
The undersigned registered agent has sent a copy of the certificate of resignation of registered agent by registered mail to the foreign limited liability company at the address on file with the Department of State specified for the mailing of process. The address for service of process is the address of the registered agent. Therefore, the undersigned registered agent has sent a copy of the certificate of resignation of registered agent by registered mail to the office of the foreign limited liability company in the jurisdiction of its formation.

X

(Signature of Registered Agent) (Type or Print Name of Registered Agent)

DOS-1370 (Rev. 5/08)

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CERTIFICATE OF RESIGNATION OF REGISTERED AGENT OF
(Insert Name of Foreign Limited Liability Company)

Under Section 302(d) 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 resignation of registered agent 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 stationery stores. The Department of State recommends that legal documents be prepared under the guidance of an attorney. The certificate must be submitted with a $20 filing fee made payable to the Department of State.

(For office use only)

DOS-1370 (Rev. 5/08)

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