Form Dos-1369-F-A - Application For Authority Page 3
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1
2
3APPLICATION FOR AUTHORITY
OF
(Insert name of Foreign Professional Service Limited Liability Company)
Under Section 1306 of the Limited Liability Company Law
Filer’s 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 limited liability company. 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 supply stores.
2. Attach a Certificate of Existence, Certificate of Good Standing or Certificate of Status from the official who files and maintains
limited liability company records in the jurisdiction of the foreign professional limited liability company’s formation.
3. The name of the foreign professional limited liability company and its date of formation provided on this document must
exactly match the name of the foreign professional limited liability company and, if applicable, the date of formation 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
nd
Washington Avenue, 2
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 application for authority must be submitted with a $200 filing fee made payable to the Department of State.
(For office use only)
Page 3 of 3
DOS-1369-f-a (Rev. 03/17)
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