DOS - 1670 - f (Rev. 03 / 1 6 ) Page 1 of 2 CERTIFICATE OF CHANGE OF (Insert Name of Domestic Corporation) Under Section 803-A of the Not-for-Profit Corporation Law (For Use By Agent) FIRST: The name of the corporation is: . If the name of the Domestic Corporation has been changed, the name under which the corporation was formed is: . SECOND: The date on which the certificate of incorporation was filed by the Department of State is: . THIRD: The only change effected hereby is: the post office address to which the Secretary of State shall mail a copy of any process against the Domestic Corporation served upon the Secretary of State is changed to: . FOURTH: The undersigned person, partnership, or corporation (hereinafter referred to as the is the agent of the Domestic Corporation to whose address the Secretary of State is required to mail copies of process against the Domestic Corporation served upon the Secretary of State. The post office address previously designated by the Domestic Corporation for that purpose was the address of the undersigned Agent, and the address specified in paragraph Third above is the new address of the undersigned Agent. The undersigned Agent mailed a notice of the proposed change of address to the Domestic Corporation not less than thirty days prior to the date of delivery of this Certificate to the Department of State. The Domestic Corporation has not objected to the change of address effected hereby. The undersigned Agent is authorized by Not-for-Profit Corporation Law section 803-A(b) to sign and deliver this Certificate. X (Signature) (Type or Print Name of "Agent") American LegalNet, Inc. www.FormsWorkFlow.com DOS - 1670 - f (Rev. 03 / 1 6 ) Page 2 of 2 CERTIFICATE OF CHANGE OF (Insert Name of Domestic Corporation) Under Section 803-A of the Not-for-Profit Corporation Law Address: City, State and Zip Code: NOTES: 1. The name of the corporation and its date of incorporation provided on this certificate must exactly match the website at www.dos.ny.gov . 2. This sample form is provided by the New York State Department of State Division of Corporations for filing a certificate of change to change the address of the agent for service of process of a domestic corporation. 3. This form is designed to satisfy the minimum filing requirements pursuant to the Not-for-Profit Corporation Law. The Division will accept any other form which complies with the applicable statutory provisions. 4. The Division recommends that this legal document be prepared under the guidance of an attorney. 5. The Division does not provide legal, accounting or tax advice. 6. This certificate must be submitted with a $20 filing fee made payable to the Department of State. For Office Use Only American LegalNet, Inc. www.FormsWorkFlow.com