Form Dos-1673-F-L - Certificate Of Change Of Application For Authority Of ___ - New York Division Of Corporations Page 2

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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 Business Corporation Law section
1309-A(c) to sign and deliver this Certificate.
(Signature)
(Type or Print Name of "Agent")
(If the “Agent” is not a natural person, type or print the name and
title of person signing this Certificate on behalf of the “Agent”)
CERTIFICATE OF CHANGE
OF
APPLICATION FOR AUTHORITY
OF
(Name of Foreign Corporation)
Under Section 1309-A of the Business Corporation Law
Filer’s Name:
Address:
City, State and Zip Code:
NOTE: 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. This
form is designed to satisfy the minimum filing requirements pursuant to the Business Corporation Law. The
Division will accept any other form which complies with the applicable statutory provisions. The Division
recommends that this legal document be prepared under the guidance of an attorney. The Division does not
provide legal, accounting or tax advice.
For Office Use Only
DOS-1673-f-l (Rev. 05/10)
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