DOS-1377-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.gov CERTIFICATE OF RESIGNATION OF REGISTERED AGENT OF (Insert Name of Domestic Limited Liability Company) Under Section 302(d) of the Limited Liability Company Law FIRST: The name of the limited liability company is: . If the name of the limited liability company has been changed, the name under which it was organized is: . SECOND: The date of filing of the original articles of organization with the Department of State is: . THIRD: The registered agent hereby resigns. FOURTH: [check appropriate statement] The undersigned registered agent has sent a copy of the certificate of resignation of registered agent by registered mail to the limited liability company at the address on file with the Department of State specified for the mailing of process. The address for service of process is the address of the registered agent. Therefore, the undersigned registered agent has sent a copy of the certificate of resignation of registered agent by registered mail to the office of the limited liability company. X (Signature of Registered Agent) (Type or Print Name of Registered Agent) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DOS-1377-f (Rev. 03/17) CERTIFICATE OF RESIGNATION OF REGISTERED AGENT OF (Insert Name of Domestic Limited Liability Company) Under Section 302(d) 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 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 of registered agent for a domestic 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 stationery 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 $20 filing fee made payable to the Department of State. (For office use only) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com