DOS-1374-f (Rev. 03/17)
Page 2 of 3
SIXTH: Complete parts 1 and 2 of this paragraph only if any of the original members and managers
are domestic or foreign professional service corporations, domestic or foreign professional service limited
liability companies, domestic or foreign registered limited liability partnerships or professional
partnerships.
1. The names of all domestic and foreign professional service corporations, domestic and foreign
professional service limited liability companies, domestic and foreign registered limited liability
partnerships and domestic and foreign professional partnerships who are to be original members and
managers of this professional service limited liability company are:
.
(Attach the appropriate certificates of existence from the jurisdiction of formation, and, in the case of foreign entities,
certificates of the New York State Secretary of State that such foreign entities are authorized to do business in New York.)
2. The names and residence addresses or, if none, the business address of all shareholders, directors,
officers, members, managers or partners of all domestic and foreign professional service corporations,
domestic and foreign professional service limited liability companies, domestic and foreign registered
limited liability partnerships and domestic and foreign professional partnerships who are to be the
original members or managers are:
.
(Attach the appropriate certificates from the licensing authority or a comparable authority of another state.)
X
(Signature of Organizer)
(Type or Print Name of Organizer)