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                                                                                                    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 
                                                                                                    www.dos.ny.gov 
 
                             CERTIFICATE OF CHANGE  

                                                       OF 
 
                             (Insert Name of Foreign Limited Liability Company) 

                          Under Section 804-A of the Limited Liability Company Law 
 
 FIRST: The name of the foreign limited liability company is: 
  
                                                                                                                                                                               . 
 If applicable, the fictitious name the foreign limited liability company has agreed to use in this state is: 
  
                                                                                                                                                                               . 
  
 SECOND:  The application for authority was filed with the Department of State on: 
  
                                                                                                 . 

 THIRD: The change(s) effected hereby are: (Check appropriate statement(s))                         
  
       The county location, within this state, in which the office of the foreign limited liability company is 

        located, is changed to:                                                                                                                                                   .
       The address to which the Secretary of State shall forward copies of process accepted on behalf of the 
      foreign limited liability company is changed to read in its entirety as follows: 
  
                                                                                                                                                                               . 

        The foreign limited liability company hereby: (check one) 

             Designates                                                                                        
             as its registered agent upon whom process against the foreign limited liability company may be 
             served. The street address of the registered agent is: 
              
                                                                                                                                                                        . 
  
 DOS-1362-f (Rev. 03/17)                                                                                                                                                                  Page 1 of 3 



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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. 

  X                                                      Capacity of signer (Check appropriate box):         
              (Signature)                                                                                                                 
                                                         Member                                                                           
                                                                                                                                          
                                                            Manager                                                                       
                                                                                                                                          
                                                            Authorized Person 
   
                          (Type or Print Name) 
  
 DOS-1362-f  (Rev. 03/17)                                                                                                                                        Page 2 of 3 



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                                             CERTIFICATE OF CHANGE  
                                                           OF 
 
                                          (Insert Name of Foreign Limited Liability Company) 
 
                               Under Section 804-A 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. The name of the foreign limited liability company and the date of filing of the application for authority must exactly match the 
     records of the Department of State.  This information should be verified on the Department of States website at  
     www.dos.ny.gov.  
 2. This form was prepared by the New York State Department of State for filing a certificate of change by a foreign limited  
     liability company.  You are not required to use this form.  You may draft your own form or use forms available at legal supply  
     stores.   
 3. The Department of State recommends that legal documents be prepared under the guidance of an attorney.   
 4. The certificate must be submitted with a $30 filing fee made payable to the Department of State. 
   
 (For office use only) 
  
 DOS-1362-f (Rev. 03/17)                                                                                               Page 3 of 3 






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