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) 

                                                                                                                      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 
 
                             CERTIFICATE OF CHANGE 

                                OF 
 
                               (Insert Name of Foreign Corporation) 
                             Under Section 1309-A of the Business Corporation Law 
 
   FIRST: The name of the corporation as it appears on the index of names in the Department of 
   State is:                                                                                                                                              . 
   (Complete the following section 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 do business in New York State is: 

                                               . 
 
   FOURTH: The change(s) effected hereby are: (Check appropriate statement(s)) 
        The county location, within this state, in which the office of the corporation is 
        located, is changed to:                                                                                                                       . 
        The post office address to which the Secretary of State shall mail a copy of any process against the 
   corporation served upon the Secretary of State by personal delivery is changed to read in its 
   entirety as follows: 

                                                                                                                                                                  . 
        The email address to which the Secretary of State shall email a notice of the fact that process 
   against the corporation has been served electronically upon the Secretary of State is: 
                                                                                                                             .  
        The email address to which the Secretary of State shall email a notice of the fact that process 
   against the corporation has been served electronically upon the Secretary of State is changed to 
   read as follows: 

                                                                                                                            . 
        The email address to which the Secretary of State shall email a notice of the fact that process 
   against the corporation has been served electronically upon the Secretary of State is deleted. 
   
 DOS-1557-f-a  (Rev. 12/22)                                                                                                                                         Page 1 of 2 

        The corporation hereby designates   

  its registered agent upon whom process against the corporation may be served. 
  The street address of the registered agent is: 
  
                                                                                                                                                                  . 
        The corporation hereby changes the designation of its registered agent to:                                                               

                                                                                                                                          .    
        The street address of the registered agent is: 

                                                                                                                                           . 
        The corporation hereby changes the address of its registered agent to: 

                                                                                                                                                                  . 
        The corporation hereby revokes the designation of its registered agent. 
 
                                                                                          Capacity of Signer (Check appropriate box): 
                 X                                                                                                                                                               
                                                                                           
                                                         (Signature)                
                                                                                            Officer 
 
                                                                                            Director                                                                  
                                     (Name of Signer) 
                                                                                            Authorized Person 

                                                                     CERTIFICATE OF CHANGE 
                                                                                     OF 
 
                                                                      (Insert Name of Foreign Corporation) 
 
                                             Under Section 1309-A of the Business Corporation Law 
  Filer’s Name and Mailing Address: 

                   Name: 

                   Company, if Applicable: 

                   Mailing Address: 

                   City, State and Zip Code: 

  NOTES:  
  1. The name of the corporation and the date it was authorized to conduct business in New York State provided on 
      this certificate must exactly match the records of the Department of State.  The information should be verified 
      on the Department of State’ s website at                        https://dos.ny.gov. 
  2. 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. 
  3. The Department of State recommends that all documents be prepared under the guidance of an attorney.  
  4. The certificate must be submitted with a $30 filing fee. 
                                                                                                                                                                     
  For Office Use Only 

 DOS-1557-f-a  (Rev. 12/22)                                                                                                                                         Page 2 of 2