Application for Authority (New York)
This is an application for authority of a foreign professional service limited liability company in New York. The form provided here is simply a sample of what the actual Form DOS-1369 looks like.
NYS Department of State
Division of Corporations, State Records and UCC
41 State Street, Albany, NY 12231-0001
www.dos.state.ny.us
APPLICATION FOR AUTHORITY
OF
_____________________________________
(Insert name of Foreign Professional Service Limited Liability Company)
Under Section 1306 of the Limited Liability Company Law
FIRST: The name of the professional service limited liability company is:
_____________________________________
If the name does not contain a required word or abbreviation pursuant to Section 1306(a)(1) of the Limited Liability Company Law, the following word or abbreviation is added to the name for its use in this state:
_____________________________________
SECOND: (A certificate of existence by an authorized officer of the jurisdiction of its formation must be attached to this application.) The jurisdiction of organization of the professional service limited liability company
is: _____________________________________
The date of its formation is: _____________________________________
THIRD: The professional service limited liability company shall practice the profession(s)
of _________________________________________ in the State of New York.
FOURTH: The professional service limited liability company is authorized to practice such profession(s) in the jurisdiction of its formation.
FIFTH: The city, incorporated village or town and the county within this state in which its office is to be located
is: _____________________________________
SIXTH: The Secretary of State is designated as agent of the professional service limited liability company upon whom process against it may be served. The address within or without this state to which the Secretary of State shall mail a copy of any process served against him or her is:
_____________________________________
_____________________________________
SEVENTH: (Attach the appropriate certificates from the licensing authority.) The name and address and, where applicable, the New York State license number of each professional within the foreign professional service limited liability company that are licensed to practice the profession or professions in New York State are:
_____________________________________
_____________________________________
____________________________________ (Signature)
____________________________________ (Type or print name)
____________________________________ (Title or capacity of signer)
APPLICATION FOR AUTHORITY
OF
____________________________________
(Insert name of Foreign Professional Service Limited Liability Company)
Under Section 1306 of the Limited Liability Company Law
Filed by: ____________________________________ (Name)
____________________________________ (Mailing address)
____________________________________ (City, State and ZIP code)