CERTIFICATE OF RESIGNATION OF REGISTERED AGENT OF (Insert Name of Domestic Corporation) Under Section 305 of the Not-for-Profit Corporation Law FIRST: The name of the corporation is: . If the name of the corporation has been changed, the original name of the corporation is: . SECOND: The certificate of incorporation was filed by the Department of State on: . THIRD: The registered agent hereby resigns. FOURTH: (Check the appropriate statement) The undersigned registered agent has sent a copy of the certificate of resignation of registered agent by registered mail to the designating corporation at the post office address on file in the Department of State specified for mailing of process. The address for mailing 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 to the office of the designating corporation in the jurisdiction of its incorporation. X (Signature of Registered Agent) (Type or Print Name of Registered Agent) DOS-1668-f (Rev. 02/16) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF RESIGNATION OF REGISTERED AGENT OF (Insert Name of Domestic Corporation) Under Section 305 of the Not-for-Profit Corporation Law Mailing 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 records of the Department of State. This information should be verified on the Department of States 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 resignation of registered agent of a domestic corporation. 3. 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 $30 filing fee made payable to the Department of State. (For DOS Use Only) DOS-1668-f (Rev. 02/16) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com