DOS-1340-f (Rev. 03/17) Page 1 of 2 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 RESIGNATION FOR RECEIPT OF PROCESS OF (Insert corporate name) Under Section 306-A of the Business Corporation Law FIRST: The name of the corporation is: . SECOND: The (check one) certificate of incorporation application for authority was filed by the Department of State on: . THIRD: The undersigned is the party whose address has been designated by the corporation as the post office address to which the Secretary of State shall mail a copy of any process served upon the Secretary of State as agent of the corporation. This party wishes to resign. The address for service of process, as designated by the corporation, is: . FOURTH: (check one) The corporation has a registered agent, but this party is not the registered agent of the corporation. Sixty days prior to the filing of this certificate of resignation for receipt of process, this party sent a copy of the certificate of resignation for receipt of process by registered or certified mail to: , the address of the registered agent of the corporation. The corporation has no registered agent. Sixty days prior to the filing of this certificate of resignation for receipt of process, this party sent a copy of the certificate of resignation for receipt of process by registered or certified mail to: , the last address of the corporation known to this party. The corporation has no registered agent and no address of the corporation is known to this party. Attached to this certificate is the affidavit of this party stating that a diligent, but unsuccessful, search was made to locate the corporation, specifying what efforts were made. American LegalNet, Inc. www.FormsWorkFlow.com DOS-1340-f (Rev. 03/17) Page 2 of 2FIFTH: The designating corporation is required to deliver to the Department of State a certificate of amendment or change providing for the designation by the corporation of a new address and that upon its failure to file such certificate, its authority to do business in this state shall be suspended, unless the corporation has previously filed a biennial statement under section four hundred eight of this chapter, in which case the address of the principal executive office stated in the last filed biennial statement shall constitute the new address for process of the corporation, and no such certificate of amendment or change need be filed. X (Signature) (Name of Signer) (Title of Signer) CERTIFICATE OF RESIGNATION FOR RECEIPT OF PROCESS OF (Insert corporate name) Under Section 306-A 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 and the date its certificate of incorporation or application for authority was filed by the Department of State 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 State Department of State for filing a certificate of resignation for receipt of process by a domestic or foreign business corporation. You are not required to use this form. You may draft your own form or use forms available at legal stationery stores. 3. 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