CERTIFICATE OF AMENDMENT 

OF 
 
(Insert Name of Foreign Corporation) 
 
Under Section 1309 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.) 
 
The fictitious name the corporation has agreed to use in New York State is: 
 
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 Application for authority is amended as follows: 
• If the true name of the foreign corporation has been changed, set forth a statement that the change of name has been 
effected under the laws of the jurisdiction of incorporation and the date the change was so effected. 
 
• If the activities it proposes to conduct in this state are to be enlarged, limited or otherwise changed, set forth a statement 
that the corporation is authorized to conduct the activities in its jurisdiction of incorporation. 
 
Paragraph of the Application for Authority is amended to read in its entirety as 

follows: 
 
                X 
  (Signature)    (Capacity of Signer) 
 
(Name of Signer) 
 DOS-1560-f  (Rev. 02/16) Page 1 of 2 

                          CERTIFICATE OF AMENDMENT 

                                                             OF 

                                      (Insert Name of Foreign Corporation) 
 
                          Under Section 1309 of the Not-for-Profit Corporation Law 
 
 Filer’s Name 

 Address 

 City, State and Zip Code 
 
 NOTES:  
 1. The name of the corporation and the date it was authorized to conduct activities in New York State provided on this 
     Certificate must exactly match the records of the Department of State.  This information should be verified on the 
     Department of State’s website at www.dos.ny.gov. 
 2. This form was prepared by the New York State Department of State. It does not contain all optional provisions under 
      the law.  
 3. You are not required to use this form. You may draft your own form or use forms available at legal stationery stores.  
 4. The Department of State recommends that all documents be prepared under the guidance of an attorney.  
 5. Please be sure to review Section 1309(c) and Section 404 of the Not-for-Profit Corporation Law to determine if  
     any consents or approvals are required to be attached to this certificate of amendment.     
 6. The certificate must be submitted with a $30 filing fee. 
 
 For Office Use Only 

 DOS-1560-f  (Rev. 02/16)                                                                                                  Page 2 of 2