Fill and Sign the Insert Name of Domestic Professional Service Corporation Form

Page 1 of 2 DOS-1523-f-l (Rev. 12/14) New York State Department of State Division of Corporations, State Records & Uniform Commercial Code One Commerce Plaza, 99 Washington Avenue Albany, NY 12231 http://www.dos.state.ny.us CERTIFICATE OF INCORPORATION OF (Insert Name of Domestic Professional Service Corporation) Under Section 1503 of the Business Corporation Law FIRST: The name of the professional service corporation is: . SECOND: The professional service corporation shall practice the profession(s) of: . THIRD: The county within this state in which the office of the professional service corporation is to be located is: . FOURTH: The corporation shall have the authority to issue one class of shares consisting of 200 common shares without par value. FIFTH: The Secretary of State is designated as agent of the professional service corporation upon whom process against it may be served. The address to which the Secretary of State shall mail a copy of any process against the professional service corporation served upon him or her is: SIXTH: (Attach the appropriate certificate(s) from the licensing authority) The names and residence addresses of all individuals who are to be the original shareholders, directors and officers of the professional service corporation are: Page 2 of 2 DOS-1523-f-l (Rev. 12/14) (Signature of Incorporator) (Typed or Printed Name of Incorporator) (Address) (City, State and Zip Code) CERTIFICATE OF INCORPORATION OF (Insert Name of Domestic Professional Service Corporation) Under Section 1503 of the Business Corporation Law Filed by: (Name) (Mailing Address) (City, State and Zip Code) NOTE: This form was prepared by the New York State Department of State for filing a certificate of incorporation for a professional service corporation. It does not contain all option 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. The Department of State recommends that legal documents be prepared under the guidance of an attorney. The certificate must be submitted with the filing fee, made payable to the Department of State, of $125. §1503(c) of the Business Corporation Law requires that a certified copy of the certificate of incorporation be filed with the licensing authority within 30 days after the date of the filing of the certificate of incorporation with the Department of State. The fee for a certified copy is $10. For DOS Use Only