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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
