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 Ave. Albany, NY 12231 www.dos.state.ny.us

CERTIFICATE OF CHANGE OF
(Insert Name of Foreign Corporation)

Under Section 1310 of the Not-for-Profit Corporation Law

FIRST: The name of the corporation as it appears on the index of names in the Department of
State is: name the corporation has agreed to use in New York State is: . . (Complete this paragraph only if the corporation has agreed to use a fictitious name in New York State. The fictitious )

SECOND: The jurisdiction of incorporation of the corporation is:
.

THIRD: The date on which the corporation was authorized to conduct activities in New York
State is: .

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

. The corporation hereby: [Check one] Designates as its registered agent upon whom process against the corporation may be served. The street address of the registered agent is: .
DOS-1558 (Rev. 9/08)

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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.

(Signature)

(Name of Signer)

(Title of Signer)

CERTIFICATE OF CHANGE OF
(Insert Name of Foreign Corporation)

Under Section 1310 of the Not-for-Profit Corporation Law

Filer's Name Address City, State and Zip Code

NOTE: This form was prepared by the New York State Department of State. 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 all documents be prepared under the guidance of an attorney. The certificate must be submitted with a $20 filing fee.
For Office Use Only

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