APPLICATION FOR AUTHORITY 

                                        OF 

                                        (Name of Foreign Corporation) 
                            Under Section 1304 of the Not-for-Profit Corporation Law 
 
 FIRST: The name of the foreign corporation is: 
 
 If the name of the corporation does not contain a required word or abbreviation indicating 
 corporate character, the corporation agrees to add the following word or abbreviation 
 to the end of its name for use in New York State: 
 
 If the corporation’s true name is not available for use in New York State pursuant to §301 and 
 §302 of the Not-for-Profit Corporation Law, the fictitious name the corporation agrees to use in 
 this state is:                                                                                    
 
 SECOND: The jurisdiction in which the corporation was organized is: 

 The date of its incorporation is:                                                                 
 
 THIRD: The corporation is a foreign corporation as defined in subparagraph (7) of paragraph (a) 
 Section 102 of the Not-for-Profit Corporation Law. 
 
 FOURTH: If formed in New York State, the corporation would be a (check the appropriate 
 box)       charitable corporation      non-charitable corporation. 
 
 FIFTH:  
 A. The purposes to be pursued in this state are: 
  
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   A. Continued. 
 
   B. The activities which it proposes to conduct in this State are: 
 
   The corporation is authorized to conduct the above activities in its jurisdiction of incorporation. 
 
   SIXTH: The county within this state in which the office of the corporation is to be located is: 
                                                           .(A county in New York State must be stated. Please note             that the 
   corporation is not required to have an actual physical office in this state.) 
 
   SEVENTH: The Secretary of State is designated as agent of the corporation upon whom process 
   against the corporation may be served. The address to which the Secretary of State shall forward 
   copies of process accepted on behalf of the corporation is: 
 
   EIGHTH: (Please check the appropriate statement.) 
                              The corporation has not, since its incorporation or since the date its authority to conduct  
                              activities in New York was last surrendered, engaged in any activity in this state except 
                              as set forth in paragraph (b) of Section 1301 of the Not-for-Profit Corporation Law. 

                              The consent of the State Tax Commission is attached. 
 
   X 
                                           (Signature)                                                     (Capacity of Signer) 
     
                             (Print or Type Signer’s Name) 

 DOS-1555-f-a  (Rev. 02/16)                                                                                                              Page 2 of 3 

                            APPLICATION FOR AUTHORITY                                       OF 

                                                (Name of Foreign Corporation) 
                            Under Section 1304 of the Not-for-Profit Corporation Law 
 
 Filer’s Name 

 Address 

 City, State and Zip Code  
 
 NOTES:  
 1. The certificate must be submitted with a $135 filing fee.  
 2. This form was prepared by the New York State Department of  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 stationery stores.  
 3. The Department of State recommends that all documents be prepared under the guidance of an attorney.  
 4. Attached to the Application for Authority must be a Certificate of Existence/Good Standing/Status from the official who  
     files and maintains corporate records in the jurisdiction of the corporation. (Please Note: This official is generally the  
     Secretary of State.) 
 5. Please be sure to review Section 404 of the Not-for-Profit Corporation Law to determine if any consents or approvals     
     are required to be attached to this application for authority. 
 
 For Office Use Only 

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