Certificate Of Assumed Name {DOS-1338-f}

New York State Department of State Division of Corporations, State Records and Uniform Commercial Code One Commerce Plaza 99 Washington Avenue Albany, NY 12231 www.dos.ny.gov Certificate of Assumed Name (Pursuant to General Business Law 247130) 1. REAL NAME OF ENTITY: 1a. FICTITIOUS NAME, IF ANY, OF FOREIGN ENTITY (Not Assumed Name): 2. THE ENTITY WAS FORMED OR AUTHORIZED UNDER THE FOLLOWING NEW YORK LAW (Check one): Business Corporation Law Limited Liability Company Law Religious Corporations Law Education Law Not-for-Profit Corporation Law Revised Limited Partnership Act Other (specify law): 3. ASSUMED NAME OF ENTITY: 4. PRINCIPAL PLACE OF BUSINESS IN NEW YORK STATE (MUST INCLUDE NUMBER AND STREET). IF NONE, CHECK THIS BOX AND PROVIDE OUT-OF- STATE ADDRESS: 5. COUNTY(IES) IN WHICH ENTITY DOES OR INTENDS TO DO BUSINESS: ALL COUNTIES (or check applicable county(ies) below) Albany Cattaraugus Chenango Delaware Franklin Hamilton Lewis Montgomery Allegany Cayuga Clinton Dutchess Fulton Herkimer Livingston Nassau Bronx Chautauqua Columbia Erie Genesee Jefferson Madison New York Broome Chemung Cortland Essex Greene Kings Monroe Niagara Oneida Orleans Queens St. Lawrence Schuyler Sullivan Warren Wyoming Onondaga Oswego Rensselaer Saratoga Seneca Tioga Washington Yates Ontario Otsego Richmond Schenectady Steuben Tompkins Wayne Orange Putnam Rockland Schoharie Suffolk Ulster Westchester 6. ADDRESS OF EACH LOCATION, INCLUDING NUMBER AND STREET, IF ANY, OF EACH PLACE WHERE THE ENTITY CARRIES ON, CONDUCTS OR TRANSACTS BUSINESS IN NEW YORK STATE. (Use page 2 if needed. The address(es) must be a number and street, city, state and zip code. The address(es) must be within the county(ies) indicated in paragraph 5.) If none, check this box : No New York State Business Location. Print or Type Name of Signer: Signature: Capacity of Signer (Check one): Authorized Person Officer of the Corporation General Partner of the Limited Partnership Member of the Limited Liability Company Manager of the Limited Liability Company DOS-1338-f (Rev. 03/17) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Certificate of Assumed Name 6. ADDRESS OF EACH LOCATION, INCLUDING NUMBER AND STREET, IF ANY, OF EACH PLACE WHERE THE ENTITY CARRIES ON OR CONDUCTS OR TRANSACTS BUSINESS IN NEW YORK STATE: (Continued) Filer222s Name and Mailing Address: Name: Company, if Applicable: Mailing Address: City, State and Zip Code: NOTE: You are not required to use this form. This certificate should be prepared under the guidance of an attorney. FEE: Limited Liability Companies and Limited Partnerships - $25. Corporations - $25 plus the fee for each county indicated in paragraph 5. The additional fee for each county within New York City (Bronx, Kings, New York, Queens and Richmond) is $100 additional. The fee for each county outside New York City is $25. Checks over $500 must be certified. (For office use only) DOS-1338-f (Rev. 03/17) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com