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 Domestic Limited Liability Company) 
                           Under Section 211-A of the Limited Liability Company Law 
 FIRST: The name of the limited liability company is: 
  
                                                                                                                                                                                                        . 
 If the name of the limited liability company has been changed, the name under which it was organized  

 is:                                                                                                                                                                  . 

 SECOND: The date of filing of the articles of organization is:                                                              . 

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

           located, is changed to:                                                                                                                       . 
    
           The post office address to which the Secretary of State shall mail a copy of any process against the 
           limited liability company 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 limited liability company 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 limited liability company 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 limited liability company has been served electronically upon the Secretary of State is 
           deleted. 
  
          The limited liability company hereby designates   
           its registered agent upon whom process against the limited liability company may be served. 
           The street address of the registered agent is: 
               
                                                                                                                                                            . 
            
 DOS-1359-f (Rev. 12/22)                                                                                                                                          Page 1 of 2 

          The limited liability company hereby changes the designation of its registered agent to:                                                               
                                                                                                                      .    
           The street address of the registered agent is: 
                                                                                                                      . 
          The limited liability company hereby changes the address of its registered agent to: 
                                                                                                                                                                        . 
                     The limited liability company hereby revokes the designation of its registered agent. 
 
           X                                                Capacity of Signer (Check appropriate box): 
  (Signature)                                                  
                                                               Member 
 
 (Type or print name)                                          Manager 
  
                                                               Authorized Person   
                                                            
                                         CERTIFICATE OF CHANGE 

                                                  OF 
 
                                          (Insert Name of Domestic Limited Liability Company) 
 
                                         Under Section 211-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 limited liability company and the date of filing of the articles of organization must exactly match the 
     records of the Department of State.  This 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 for filing a certificate of change by a domestic 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-1359-f (Rev. 12/22)                                                                                                                                                      Page 2 of 2