Free Certificate of Surrender of Authority 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

CERTIFICATE OF SURRENDER OF AUTHORITY OF
(Insert Name of Foreign Corporation)

Under Section 1311 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: (Complete this paragraph only if the corporation has agreed to use a fictitious name in New York State. name the corporation has agreed to use in New York State is: ) The fictitious

SECOND: The jurisdiction of incorporation of the corporation is:

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

FOURTH: The corporation surrenders its authority to conduct activities in New York State. FIFTH: The corporation revokes the authority of its registered agent, if any, previously designated.
SIXTH: The corporation consents that process against it in any action or special proceeding based upon any liability or obligation incurred by it within this state before the filing of the certificate of surrender of authority may be served on the Secretary of State after the filing thereof in the manner set forth in paragraph (b) of Section 306 (Service of process). The address to which the Secretary of State shall mail a copy of any process against it served upon him is:

.
(Signature) (Name and Capacity of Signer)

DOS-1564 (9/08)

CERTIFICATE OF SURRENDER OF AUTHORITY OF
(Insert Name of Foreign Corporation)

Under Section 1311 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 requires the consent of the State Tax Commission. The certificate must be submitted with a $30 filing fee.

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