DOS-1373-f (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.govCERTIFICATE OF RESIGNATION FOR RECEIPT OF PROCESS OF (Insert Name of Limited Liability Company) Under Section 301-A of the Limited Liability Company Law FIRST: The name of the limited liability company is: . FOREIGN ENTITIES ONLY. If applicable, the fictitious name the limited liability company agreed to use in New York State is: . SECOND: The [check one] articles of organization application for authority was filed by the Department of State on: . THIRD: The undersigned is the party whose address has been designated by the limited liability company as the address to which the Secretary of State shall mail a copy of any process served upon the Secretary of State as agent of the limited liability company. This party wishes to resign. The address for service of process, as designated by the limited liability company, is: . FOURTH: [check one] The limited liability company has a registered agent, but this party is not the registered agent of the limited liability company. 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 limited liability company. The limited liability company 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 limited liability company known to this party. The limited liability company has no registered agent and no address of the limited liability company 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 limited liability company, specifying what efforts were made. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DOS-1373-f (Rev. 03/17) FIFTH: The designating limited liability company is required to deliver to the Department of State a certificate of amendment or change providing for the designation by the limited liability company of a new address and that upon its failure to file such certificate, its authority to do business in this state shall be suspended. X (Signature) (Name of Signer) (Title of Signer) CERTIFICATE OF RESIGNATION FOR RECEIPT OF PROCESS OF (Insert Name of Limited Liability Company) Under Section 301-A of the Limited Liability Company Law Filer222s Name and Mailing Address: Name: Company, if Applicable: Mailing Address: City, State and Zip Code: NOTES: 1. The name of the limited liability company and the date of filing of the articles of organization or application for authority 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 limited liability company. You are not required to use this form. You may draft your own form or use forms available at legal supply stores. 3. The Department of State recommends that legal documents be prepared under the guidance of an attorney. 4. The certificate must be submitted with a $10 filing fee made payable to the Department of State. (For office use only) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com