Fillable Certificate of Assumed Name (New York State)

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Certificate of Assumed Name (New York State)

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The Certificate of Assumed Name (New York State) form is 2 pages long and contains:

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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
Certificate of Assumed Name
(Pursuant to General Business Law §130)
1. REAL NAME OF ENTITY:
1a. FICTITIOUS NAME, IF ANY, OF FOREIGN ENTITY (Not Assumed Name):
2. THE ENTITY WAS FORMED OR AUTHORIZED UNDER THE FOLLOWING NEW YORK LAW (Check one):
Business Corporation Law Limited Liability Company Law Religious Corporations Law
Education Law Not-for-Profit Corporation Law Revised Limited Partnership Act
Other (specify law):
3. ASSUMED NAME OF ENTITY:
4. PRINCIPAL PLACE OF BUSINESS IN NEW YORK STATE (MUST INCLUDE NUMBER AND STREET). IF NONE, CHECK
THIS BOX
AND PROVIDE OUT-OF- STATE ADDRESS:
5. COUNTY(IES) IN WHICH ENTITY DOES OR INTENDS TO DO BUSINESS:
ALL COUNTIES (or check applicable county(ies) below)
Albany Cattaraugus Chenango Delaware Franklin Hamilton Lewis Montgomery
Allegany Cayuga Clinton Dutchess Fulton Herkimer Livingston Nassau
Bronx Chautauqua Columbia Erie Genesee Jefferson Madison New York
Broome Chemung Cortland Essex Greene Kings Monroe Niagara
Oneida Orleans Queens St. Lawrence Schuyler Sullivan Warren Wyoming
Onondaga Oswego Rensselaer Saratoga Seneca Tioga Washington Yates
Ontario Otsego Richmond Schenectady Steuben Tompkins Wayne
Orange Putnam Rockland Schoharie Suffolk Ulster Westchester
6. ADDRESS OF EACH LOCATION, INCLUDING NUMBER AND STREET, IF ANY, OF EACH PLACE WHERE THE ENTITY
CARRIES ON, CONDUCTS OR TRANSACTS BUSINESS IN NEW YORK STATE. (Use page 2 if needed. The address(es)
must be a number and street, city, state and zip code. The address(es) must be within the county(ies) indicated in paragraph
5.) If none, check this box
: No New York State Business Location.
Print or Type
Name of Signer: Signature:
Capacity of Signer (Check one):
Authorized Person Officer of the Corporation General Partner of the Limited Partnership

Member of the Limited Liability Company Manager of the Limited Liability Company
DOS-1338-f (Rev. 03/17) Page 1 of 2
Certificate of Assumed Name
6. ADDRESS OF EACH LOCATION, INCLUDING NUMBER AND STREET, IF ANY, OF EACH PLACE WHERE THE ENTITY
CARRIES ON OR CONDUCTS OR TRANSACTS BUSINESS IN NEW YORK STATE: (Continued)
Filer’s Name and Mailing Address:
Name:
Company, if Applicable:
Mailing Address:
City, State and Zip Code:
NOTE: You are not required to use this form. This certificate should be prepared under the guidance of an attorney.
FEE: Limited Liability Companies and Limited Partnerships - $25.
Corporations - $25 plus the fee for each county indicated in paragraph 5. The additional fee for each county within New
York City (Bronx, Kings, New York, Queens and Richmond) is $100 additional. The fee for each county outside New York
City is $25. Checks over $500 must be certified.
(For office use only)
DOS-1338-f (Rev. 03/17) Page 2 of 2
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Certificate of Assumed Name (New York State)

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Completed 24 May 2021

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