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DOS-1707-f-l (Rev. 06/12)
New York State
Department of State
Division of Corporations, State Records and Uniform Commercial Code
One Commerce Plaza, 99 Washington Avenue
Albany, NY 12231
www.dos.ny.gov
(Name of Foreign Limited Liability Company)
Under Section 802 of the Limited Liability Company Law
The undersigned is the
of
If the name of the foreign limited liability company has changed, the name under which it was
authorized is:
If applicable, the fictitious name the foreign limited liability company has agreed to use in this
state is:
The application for authority was filed by the Department of State on:
The published notices described in the annexed affidavits of publication contain all of the
information required by Section 802 of the Limited Liability Company Law.
The newspapers described in such affidavits of publication satisfy the requirements set forth in
the Limited Liability Company Law and the designation made by the county clerk.
I certify the foregoing statements to be true under penalties of perjury.
CERTIFICATE OF PUBLICATION
OF
(Signature)
(Date)
X
(Type or Print Name)
(Name of Foreign Limited Liability Company)
(Check appropriate box)
Member Manager
Authorized Person
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DOS-1707-f-l (Rev. 06/12)
(Name of Foreign Limited Limited Company)
Under Section 802 of the Limited Liability Company Law
Filed by:
(Name)
(Mailing address)
(City, State and ZIP code)
CERTIFICATE OF PUBLICATION
OF
(For office use only)
Note: This form was prepared by the New York State Department of State for filing a certificate of publication for a foreign
limited liability company. You are not required to use this form. You may draft your own form or use forms available from legal
stationery stores. The Department of State recommends that legal documents be prepared under the guidance of an attorney.
This certificate of publication, with the affidavits of publication of the newspapers annexed thereto, must be submitted with a $50
filing fee payable to the Department of State.
Attach this page after the affidavits of publication.