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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)

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