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 

                                     APPLICATION FOR AUTHORITY 

                                                              OF 
 
                                     (Insert Name of Foreign Professional Service Corporation) 
                                     Under Section 1530 of the Business Corporation Law 

                     FIRST:    The name of the foreign professional service corporation is: 
 
                                                                                                                                                                                                                                                                                                                            . 
                    If the name does not contain the required words or abbreviation pursuant to Section 1530(a)(1) 
                    of the Business Corporation Law, the following words or abbreviation is added to the name for 
                    its use in this State:                                                                                                                        . 
 
                     (Do not complete this section unless the corporation’s true name is not available for use in this state pursuant to 
                     §301 and §302 Business Corporation Law.) The fictitious name the foreign professional service 
                     corporation agrees to use in New York State is: 
 
                                                                                                                                                                                          . 

                     SECOND: The jurisdiction of incorporation of the foreign professional service corporation 
                     is:                                                                                           .  

                     The date of its incorporation is:                                            . 
 
                     THIRD:    The foreign professional service corporation shall practice the profession(s) of 
                                                                                                                      in the State of New York. 

                    FOURTH:  The foreign professional service corporation is authorized to practice such  
                   profession(s) in the jurisdiction of its incorporation. 
 
                     FIFTH: The name, address and license number of each person within the foreign 
                     professional service corporation who is licensed to practice the profession(s) in this state are: 
 
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  SIXTH:              The city, incorporated village or town and the county within this state in which its 
  office is to be located is:                                                                                                                  (The city, incorporated  
  village or town and 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 foreign professional service 
   corporation upon whom process against it may be served.  The address within or without this state 
   to which the Secretary of State shall mail a copy of any process served against him or her is: 
 
                                                                                                                                                                         . 

   EIGHTH: (Check the statement that applies.) 
 
                      The foreign professional service corporation has not since its incorporation or since the date 
                      its authority to do business in New York State was last surrendered, engaged in any activity 
                      in this State. 
 
                      The consent of the State Tax Commission is attached. 
 
                    X                                                                                                                                                    
   (Signature)                                                                                                                (Signer’s Title) 
 
   (Signer’s Name) 

  DOS-1627-f-a (Rev. 03/17)                                                                                                                                              Page 2 of 3

                            APPLICATION FOR AUTHORITY 
                                                   OF 
 
                            (Insert name of Foreign Professional Service Corporation) 
 
                            Under Section 1530 of the Business Corporation 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 by a  
       foreign professional service corporation. 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.  
   2. Attach a Certificate of Existence, Certificate of Good Standing or Certificate of Status from the official who files and  
       maintains incorporation records in the jurisdiction of the corporation’s formation. 
   3. The name of the corporation and its date of incorporation must exactly match the name of the corporation and, if  
       applicable, the date of incorporation stated in the Certificate of Existence, Certificate of Good Standing or Certificate  
       of Status. 
   4. A certificate of Good Standing from the appropriate Appellate Division or a Certificate of Authority  (Form PLS709)  
       under seal from the New York State Department of Education, Division of Professional Licensing Services,  
                                               nd
       Corporations Unit, 89 Washington Avenue, 2  Floor, Albany, NY 12234, must be submitted with the Application for 
       Authority. 
   5. The Department of State recommends that legal documents be prepared under the guidance of an attorney.  

   6. The certificate must be submitted with a $200 filing fee made payable to the Department of State. 
   (For Office Use Only) 

  DOS-1627-f-a (Rev. 03/17)                                                                                              Page 3 of 3