DOS-1626-f (Rev. 03/17) Page 1 of 3 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.govCERTIFICATE OF AMENDMENT OF CERTIFICATE OF ASSUMED NAME OF (Insert Real Name of Entity) Under Section 130 of the General Business Law FIRST: The real name of the entity is: . SECOND: Foreign entities only. If applicable, the fictitious name the entity agreed to use in New York State is: . THIRD: If the real name of the entity is different on the last Certificate of Assumed Name or Certificate of Amendment of Certificate of Assumed Name, the previous name of the entity is: . FOURTH: The entity was formed or authorized under (indicate law): Business Corporation Law Education Law Not-for-Profit Corporation Law Revised Limited Partnership Act Insurance Law Other (specify law): Limited Liability Company Law . FIFTH: The present assumed name is . SIXTH: The date the original Certificate of Assumed Name was filed is: . SEVENTH: The date, if applicable, the last Certificate of Amendment of Certificate of Assumed Name was filed is: . EIGHTH: The following change(s) are being made (check the appropriate change(s)): Entity Name: The new name of the entity is: . Assumed Name: The new assumed name is: . Principal Place of Business: The principal place of business is changed to (include the number and street, city, state and zip code) : . American LegalNet, Inc. www.FormsWorkFlow.com DOS-1626-f (Rev. 03/17) Page 2 of 3 County(ies), Added or Deleted, in Which Business Will be Conducted Under the Assumed Name: County(ies) Added: County(ies) Deleted: Address(es) of Specific Business Location(s), Added or Deleted: Business Location(s) Added (include the Business Location(s) Deleted (include the number and street, city, state and zip code): number and street, city, state and zip code): INSTRUCTIONS FOR SIGNING: 1. If a corporation, by an officer; if a limited partnership, by a general partner; if a limited liability company, by a member or manager; or by an authorized person or attorney-in-fact for such corporation, limited partnership or limited liability company. 2. If the certificate is signed by an attorney-in-fact, include the name and title of the person for whom the attorney-in-fact is acting. (Example, John Smith, attorney-in-fact for Robert Johnson, president.) X (Name of Signer) (Signature) (Title of Signer) American LegalNet, Inc. www.FormsWorkFlow.com DOS-1626-f (Rev. 03/17) Page 3 of 3 CERTIFICATE OF AMENDMENT OF CERTIFICATE OF ASSUMED NAME OF (Insert Real Name of Entity) Under Section 130 of the General Business Law Filer222s Name and Mailing Address: Name: Company, if Applicable: Mailing Address: City, State and Zip Code: NOTES: 1. This form was prepared by the New York State 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. 2. The Department of State recommends that all documents be prepared under the guidance of an attorney. 3. Filing Fee: a. Limited Liability Companies $25. b. Limited Partnerships - $25. c. Corporations - $25 plus the additional fee for each county affected by the amendment. The additional fee for each county within New York City (Bronx, Kings, New York, Queens and Richmond) is $100. The additional fee for each county outside New York City is $25. 4. Checks are payable to the Department of State. 5. All checks over $500 must be certified. For Office Use Only American LegalNet, Inc. www.FormsWorkFlow.com