New York State 
                                                                         Department of State 
                                                               DIVISION OF CORPORATIONS, 
                                                                         STATE RECORDS AND  
                                                               UNIFORM COMMERCIAL CODE 
                                                                         One Commerce Plaza 
                                                                         99 Washington Ave. 
                                                                         Albany, NY 12231-0001 
                                                                         https://dos.ny.gov                                         
DOCUMENT AND CERTIFICATE COVER SHEET 

Contact Information 
 
Name:   ______________________________________________________________________________ 
 
Mailing Address:_______________________________________________________________________ 
                   
              _____________________________________________________________________________ 
 
Email Address: ______________________________________________________________________ 
 
Phone Number:  ______________________________________________________________________ 
 
Request for Filing of Document 
 
Exact Name of Entity: __________________________________________________________ 
____________________________________________________________ 
 
Document Type:_______________________________________________________________  
                                   (i.e., Certificate of Incorporation, Articles of Organization, Certificate of Amendment, etc.): 
 
Request for Copies or Certificates of Status (Check the appropriate box) 
 
Exact Name of Entity: __________________________________________________________ 

□ Certified Copies of all Documents on File ($10 per document) 

□ Plain Copies of all Documents on File ($5 per document) 

□Certified Copy of _____________________________________________________ ($10 per document) 
                               (specify document) 

□ Plain Copy of ________________________________________________________ ($5 per document) 
                               (specify document) 

□ Certificate of Status - Long Form ($25 per document) 

□ Certificate of Status - Short Form ($25 per document)   
 
Method of Delivery of Filing Receipt or Other Document  

All documents will be returned to the email address listed above with the exception of certified and 
uncertified copies filed before July 1990. 

DOS-2183-f (04/22) 

                                                                                                                    Department of State 
                                                                                                                    DIVISION OF CORPORATIONS, 
                                                                                                                    STATE RECORDS AND  
                                                                                                                    UNIFORM COMMERCIAL CODE 
                                                                                                                    One Commerce Plaza 
                                                                                                                    99 Washington Ave. 
                                                                                                                    Albany, NY 12231-0001 
                                                                                                                    https://dos.ny.gov 
  
                                 APPLICATION FOR AUTHORITY  

                                                         OF 
 
                                      (Insert name of Foreign Limited Liability Company) 
                                 Under Section 802 of the Limited Liability Company Law 
 
 FIRST:   The name of the foreign limited liability company is: 
  
                                                                                                                                                                          . 
 The fictitious name under which the foreign limited liability company will do business in New York is: 
  
                                                                                                                                                                           . 
  
 (Complete only if the foreign limited liability company’s true name is not acceptable for authorization pursuant to §204 of the 
 Limited Liability Company Law. The fictitious name must contain the words "Limited Liability Company" or the abbreviation 
 "LLC" or "L.L.C.") 
  
 SECOND: The jurisdiction of organization of the foreign limited liability company is:                               
   
                                                                                                                                                          .        

  The date of its organization is:                                                                                . 

 THIRD: The county within New York State in which the office of the foreign limited liability company 
 is to be located or if the foreign limited liability company shall maintain more than one office in this state, 
 the county within New York State in which the principal office of the foreign limited liability company is 
 to be located is:                                                                                                                                       . 
 (Complete with the name of a New York State county. Please note that the limited liability company is not required to have an 
   actual physical office in New York State.) 

 FOURTH:           The Secretary of State is designated as agent of the foreign limited liability company upon 
 whom process against the foreign limited liability company may be served. 
          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 by personal delivery is: 
  
                                                                                                                                                                           . 
          (Optional) The email address to which the Secretary of State shall email a notice of the fact that 
          process against the foreign limited liability company has been served electronically upon the 
          Secretary of State is: 

 DOS-1361-f-a (Rev. 12/22)                                                                                                   Page 1 of 3 

  FIFTH: (Check and complete the statement that applies) 
        The foreign limited liability company is required to maintain an office in the jurisdiction of its formation.  
  The address of its office is: 
 
                                                                                                                                                                              . 
        The foreign limited liability company is not required to maintain an office in the jurisdiction of its 
  formation.  
  The address of the principal office of the foreign limited liability company is: 
   
                                                                                                                                                                              .                         

   SIXTH: The foreign limited liability company is in existence in its jurisdiction of formation at the time 
  of the filing of this application. 

  SEVENTH: The Articles of Organization of the foreign limited liability company were filed with the 
  following officer in the jurisdiction of its formation:  

  Officer (e.g. "Secretary of State"):                                                                                                                       . 

  The address of the officer is:                                                                                                                           
                                                                                                                                                                                          
                                                                                                                                                             . 
 
  X                                                                   Capacity of signer (Check appropriate box):      
                                           (Signature) 
                                                                  Member 
 
                                                                  Manager           
                                                                  Authorized Person                                                                      
                                       (Type or print name) 

  DOS-1361-f-a (Rev. 12/22)                                                                                                                                        Page 2 of 3 

                                     APPLICATION FOR AUTHORITY 
                                                              OF 
 
                                     (Insert name of Foreign Limited Liability Company) 
                                                              
                                     Under Section 802 of the Limited Liability Company Law 
 
   Filer’s Name and Mailing Address: 

           Name: 

           Company, if Applicable: 

           Mailing Address: 

           City, State and Zip Code: 

   NOTES:  
   1. This form was prepared by the New York State Department of State for filing an application for authority for a 
       foreign limited liability company to conduct business in New York State.  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  
       supply stores. 
   2. Attach a Certificate of Existence, Certificate of Good Standing or Certificate of Status from the official who files  
       and maintains limited liability company records in the jurisdiction of the foreign limited liability company’s  
       formation. 
   3. The name of the foreign limited liability company and its date of formation provided on this document must exactly 
       match the name of the foreign limited liability company and, if applicable, the date of formation stated in the  
       Certificate of Existence, Certificate of Good Standing or Certificate of Status. 
   4. The Department of State recommends that legal documents be prepared under the guidance of an attorney. 
   5. The application for authority must be submitted with a $250 filing fee made payable to the Department of State. 
   
  (For office use only.) 
 
 DOS-1361-f-a (Rev. 12/22)                                                                           Page 3 of 3