Page 1of 3DOS-1361-f-a (Rev. 03/17) Department 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 APPLICATION FOR AUTHORITY OF (Insert name of Foreign Limited Liability Company) Under Section 802 of the Limited Liability Company Law FIRST: The name of the foreign limited liability company is: . If the name does not contain the required words or abbreviation pursuant to Section 204 of the Limited Liability Company Law, the following words or abbreviation is added to the name for use in this state: . (Do not complete this section unless the foreign limited liability company222s true name is not available pursuant to 247204 of the Limited Liability Company Law.) The fictitious name under which the foreign limited liability company will do business in New York is: . (The fictitious name must contain the words "Limited Liability Company" or abbreviation "LLC" or "L.L.C.") SECOND: The jurisdiction of organization of the foreign limited liability company is: . The date of its organization is: . THIRD: The county within New York state in which the office, or if more than one office, the principal office of the foreign limited liability company is to be located is: . (A county in New York is required. Please note that the limited liability company is not required to have an actual physical office in this state.) FOURTH: The Secretary of State is designated as agent of the foreign 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: . American LegalNet, Inc. www.FormsWorkFlow.com Page 2of 3DOS-1361-f-a (Rev. 03/17) FIFTH: (Check and complete the statement that applies) The address of the office required to be maintained in the jurisdiction of its formation is: . No office is required to be maintained in the jurisdiction of its formation. The address of the principal office of the foreign limited liability company is: . SIXTH: The foreign limited liability company is in existence in its jurisdiction of formation at the time of filing of this application. SEVENTH: The authorized officer (e.g. "Secretary of State") in its jurisdiction of its formation where a copy of its articles of organization is filed is: . The address of the authorized officer is: . X (Signature) (Type or print name) Capacity of signer (Check appropriate box): Member Manager Authorized Person American LegalNet, Inc. www.FormsWorkFlow.com Page 3of 3DOS-1361-f-a (Rev. 03/17) APPLICATION FOR AUTHORITY OF (Insert name of Foreign Limited Liability Company) Under Section 802 of the Limited Liability Company 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 for filing an application for authority for a foreign limited liability company to conduct business in New York State. It does not contain all optional provisions under the law. You are not required to use this form. You may draft your own form or use forms available at legal supply stores. 2. Attach a Certificate of Existence, Certificate of Good Standing or Certificate of Status from the official who files and maintains limited liability company records in the jurisdiction of the foreign limited liability company222s formation. 3. The name of the foreign limited liability company and its date of formation provided on this document must exactly match the name of the foreign limited liability company and, if applicable, the date of formation stated in the Certificate of Existence, Certificate of Good Standing or Certificate of Status. 4. The Department of State recommends that legal documents be prepared under the guidance of an attorney. 5. The application for authority must be submitted with a $250 filing fee made payable to the Department of State. (For office use only.) American LegalNet, Inc. www.FormsWorkFlow.com