Page 1of 2DOS-1633-f (Rev. 03/17) New York StateDepartment of State DIVISION OF CORPORATIONS, STATE RECORDS AND UNIFORM COMMERCIAL CODE One Commerce Plaza 99 Washington Ave. Albany, NY 12231-0001 www.dos.ny.gov CERTIFICATE OF AMENDMENT OF CERTIFICATE OF SURRENDER OF AUTHORITY OF (Insert Name of Foreign Corporation) Under Section 1310 of the Business Corporation Law FIRST: The name of the corporation is: . The fictitious name the corporation has agreed to use in New York State, if applicable, is: . SECOND: The jurisdiction of incorporation of the corporation is: . THIRD: The date the certificate of surrender of authority was filed with the Department of State is: . FOURTH: The changed address to which the Secretary of State shall mail a copy of any process against it served upon him or her is: . X (Signature) (Name of Signer) (Title of Signer) American LegalNet, Inc. www.FormsWorkFlow.com Page 2of 2DOS-1633-f (Rev. 03/17) CERTIFICATE OF AMENDMENT OF CERTIFICATE OF SURRENDER OF AUTHORITY OF (Insert Name of Foreign Corporation) Under Section 1310 of the Business Corporation Law Filer222s Name and Mailing Address: Name: Company, if Applicable: Mailing Address: City, State and Zip Code: NOTES: 1. The name of the corporation provided on this certificate must exactly match the records of the Department of State. This information should be verified on the Department of State222s website at www.dos.ny.gov. 2. This form was prepared by the New York Department of State. You are not required to use this form. You may draft your own form or use forms available at legal stationery stores. 3. The Department of State recommends that all documents be prepared under the guidance of an attorney. 4. The certificate must be submitted with a $60 filing fee, made payable to the Department of State. For Office Use Only American LegalNet, Inc. www.FormsWorkFlow.com