Fillable CERTIFICATE OF CHANGE OF (New York State)

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CERTIFICATE OF CHANGE OF (New York State)

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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
CERTIFICATE OF CHANGE
OF
(Name of Domestic Corporation)
Under Section 805-A of the Business Corporation Law
(for use by agent)
FIRST: The name of the corporation is:
.
Said corporation is hereinafter referred to as the “Domestic Corporation.”
If the name of the Domestic Corporation has been changed, the name under which the corporation
was formed is: .
SECOND: The date on which the certificate of incorporation was filed by the Department of State
is: .
THIRD: The only change effected hereby is the post office address to which the Secretary of
State shall mail a copy of any process against the Domestic Corporation served upon the Secretary
of State is changed to:
.
FOURTH:
The undersigned person, partnership, or corporation (hereinafter referred to as the
“Agent”) is the agent of the Domestic Corporation to whose address the Secretary of State is
required to mail copies of process against the Domestic Corporation served upon the Secretary of
State. The post office address previously designated by the Domestic Corporation for that purpose
was the address of the undersigned Agent, and the address specified in paragraph Third above is the
DOS-1672-f (Rev. 03/17) Page 1 of 2
new address of the undersigned Agent. The undersigned Agent mailed a notice of the proposed
change of address to the Domestic Corporation not less than thirty days prior to the date of delivery
of this Certificate to the Department of State. The Domestic Corporation has not objected to the
change of address effected hereby. The undersigned Agent is authorized by Business Corporation
Law section 805-A(b) to sign and deliver this Certificate.
X
(Signature) (Type or Print Name of “Agent”)
If the “Agent” is not a natural person, type or print the name
and title of person signing this Certificate on behalf of the
“Agent”
CERTIFICATE OF CHANGE
OF
(Name of Domestic Corporation)
Under Section 805-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 its date of incorporation 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 sample form is provided by the New York State Department of State for filing
a certificate of change to
change the address of the agent for service of process of a domestic corporation.
3. This form is
designed to satisfy the minimum filing requirements pursuant to the Business Corporation Law.
The Division will accept
any other form which complies with the applicable statutory provisions.
4. The Division recommends that this legal
document be prepared under the guidance of an attorney. The Division
does not provide legal, accounting or tax advice.
5.
This certificate must be submitted with a $5 filing fee made payable to the “Department of State.”
DOS Use Only
DOS-1672-f (Rev. 02/17) Page 2 of 2
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CERTIFICATE OF CHANGE OF (New York State)

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Completed 7 September 2021

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