Application For Authority Foreign Professional Service Corp {DOS-1627-f-a}

DOS-1627-f-a (Rev. 03/17) Page 1 of 3New York StateDepartment of State DIVISION OF CORPORATIONS, STATE RECORDS AND UNIFORM COMMERCIAL CODE One Commerce Plaza 99 Washington Ave. Albany, NY 12231-0001 www.dos.ny.govAPPLICATION FOR AUTHORITY OF (Insert Name of Foreign Professional Service Corporation) Under Section 1530 of the Business Corporation Law FIRST: The name of the foreign professional service corporation is: . If the name does not contain the required words or abbreviation pursuant to Section 1530(a)(1) of the Business Corporation Law, the following words or abbreviation is added to the name for its use in this State: . (Do not complete this section unless the corporation222s true name is not available for use in this state pursuant to 247301 and 247302 Business Corporation Law.) The fictitious name the foreign professional service corporation agrees to use in New York State is: . SECOND: The jurisdiction of incorporation of the foreign professional service corporation is: . The date of its incorporation is: . THIRD: The foreign professional service corporation shall practice the profession(s) of in the State of New York. FOURTH: The foreign professional service corporation is authorized to practice such profession(s) in the jurisdiction of its incorporation. FIFTH: The name, address and license number of each person within the foreign professional service corporation who is licensed to practice the profession(s) in this state are: American LegalNet, Inc. www.FormsWorkFlow.com DOS-1627-f-a (Rev. 03/17) Page 2 of 3SIXTH: The city, incorporated village or town and the county within this state in which its office is to be located is: (The city, incorporated village or town and county in New York State must be stated. Please note that the corporation is not required to have an actual physical office in this state.) SEVENTH: The Secretary of State is designated as agent of the foreign professional service corporation upon whom process against it may be served. The address within or without this state to which the Secretary of State shall mail a copy of any process served against him or her is: . EIGHTH: (Check the statement that applies.) The foreign professional service corporation has not since its incorporation or since the date its authority to do business in New York State was last surrendered, engaged in any activity in this State. The consent of the State Tax Commission is attached. X (Signature) (Signer222s Title) (Signer222s Name) American LegalNet, Inc. www.FormsWorkFlow.com DOS-1627-f-a (Rev. 03/17) Page 3 of 3APPLICATION FOR AUTHORITY OF (Insert name of Foreign Professional Service Corporation) Under Section 1530 of the Business Corporation Law Filer222s Name and Mailing Address: Name Company, if Applicable Mailing Address City, State and Zip Code NOTES: 1. This form was prepared by the New York State Department of State for filing an application for authority by a foreign professional service corporation. 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. 2. Attach a Certificate of Existence, Certificate of Good Standing or Certificate of Status from the official who files and maintains incorporation records in the jurisdiction of the corporation222s formation. 3. The name of the corporation and its date of incorporation must exactly match the name of the corporation and, if applicable, the date of incorporation stated in the Certificate of Existence, Certificate of Good Standing or Certificate of Status. 4. A certificate of Good Standing from the appropriate Appellate Division or a Certificate of Authority (Form PLS709) under seal from the New York State Department of Education, Division of Professional Licensing Services, Corporations Unit, 89 Washington Avenue, 2nd Floor, Albany, NY 12234, must be submitted with the Application for Authority. 5. The Department of State recommends that legal documents be prepared under the guidance of an attorney. 6. The certificate must be submitted with a $200 filing fee made payable to the Department of State. (For Office Use Only) American LegalNet, Inc. www.FormsWorkFlow.com