Page 1of 3DOS-1369-f-a (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 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 foreign professional service limited liability company is: . If the name does not contain the required words or abbreviation pursuant to Section 1306(a)(1) of the Limited Liability Company Law, the following words or abbreviation is added to the end of its name for use in this state: . SECOND: The jurisdiction of organization of the foreign professional service limited liability company is: . The date of its formation is: . THIRD: The foreign professional service limited liability company shall practice the profession(s) of in the State of New York. FOURTH: The foreign 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 New York State in which its office is to be located is: . (A city, incorporated village or town and county in New York State must be stated. Please note that the foreign limited liability company is not required to have an actual physical office in this state.) SIXTH: The Secretary of State is designated as agent of the foreign 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: . American LegalNet, Inc. www.FormsWorkFlow.com Page 2of 3DOS-1369-f-a (Rev. 03/17) SEVENTH: The name and address and, where applicable, the New York State license number of each professional within the foreign professional service limited liability company who is licensed to practice the profession or professions in New York State 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-1369-f-a (Rev. 03/17) APPLICATION FOR AUTHORITY OF (Insert name of Foreign Professional Service Limited Liability Company) Under Section 1306 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 by a foreign professional service limited liability company. 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 professional limited liability company222s formation. 3. The name of the foreign professional limited liability company and its date of formation provided on this document must exactly match the name of the foreign professional 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. A certificate of Good Standing from the appropriate Appellate Division or a Certificate of Authority (Form PLS709) under seal from the New York State Department of Education, Division of Professional Licensing Services, Corporations Unit, 89 Washington Avenue, 2nd Floor, Albany, NY 12234, must be submitted with the Application for Authority. 5. The Department of State recommends that legal documents be prepared under the guidance of an attorney. 6. The application for authority must be submitted with a $200 filing fee made payable to the Department of State. (For office use only) American LegalNet, Inc. www.FormsWorkFlow.com