DOS - 1671 - f (Rev. 03 / 1 6 ) Page 1 of 2 CERTIFICATE OF CHANGE OF APPLICATION FOR AUTHORITY OF (Name of Foreign Corporation) Under Section 1310 of the Not-for-Profit Corporation Law (For Use By Agent) FIRST: The name of the foreign corporation, as it appears on the index of names of existing domestic and authorized foreign corporations in the Department of State, Division of Corporation, is: . If applicable: The fictitious name the Foreign Corporation has agreed to use in New York State is: . SECOND: The jurisdiction of incorporation of the Foreign Corporation is: . THIRD: The date on which the Foreign Corporation was authorized to do business in New York State was: . FOURTH: 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 Foreign Corporation served upon the Secretary of State is changed to: .FIFTH: The undersigned person, partnership, or corporation (hereinafter referred to as the is the agent of the Foreign Corporation to whose address the Secretary of State is required to mail copies of process against the Foreign Corporation served upon the Secretary of State. The post office address previously designated by the Foreign Corporation for that purpose was the address of the undersigned Agent, and the address specified in paragraph Fourth above is the new address of the undersigned Agent. The undersigned Agent mailed a notice of the proposed change of address to the Foreign Corporation not less than thirty days prior to the date of delivery of this (Continued) American LegalNet, Inc. www.FormsWorkFlow.com DOS - 1671 - f (Rev. 03 / 1 6 ) Page 2 of 2 Certificate to the Department of State. The Foreign Corporation has not objected to the change of address effected hereby. The undersigned Agent is authorized by Not-for-Profit Corporation Law section 1310(c) to sign and deliver this Certificate. X (Signature) (Type or Print Name of "Agent") (If CERTIFICATE OF CHANGE OF APPLICATION FOR AUTHORITY OF (Name of Foreign Corporation) Under Section 1310 of the Not-for-Profit Corporation Law Address: City, State and Zip Code: NOTES: 1. The name of the corporation and the date it was authorized to conduct activities in New York State provided on this certificate must exactly match the records of the Department of State. This information should be 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 foreign 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