https://dos.ny.gov
DOCUMENT AND CERTIFICATE COVER SHEET
New York State
Department of State
DIVISION OF CORPORATIONS,
STATE RECORDS AND
UNIFORM COMMERCIAL CODE
One Commerce Plaza
99 Washington Ave.
Albany, NY 12231-0001
Contact Information
Name: ______________________________________________________________________________
Mailing Address:_______________________________________________________________________
_____________________________________________________________________________
Email Address: ______________________________________________________________________
Phone Number:
______________________________________________________________________
Request for Filing of Document
Exact Name of Entity: __________________________________________________________
____________________________________________________________
Document Type:_______________________________________________________________
(i.e., Certificate of Incorporation, Articles of Organization, Certificate of Amendment, etc.):
Request for Copies or Certificates of Status
(Check the appropriate box)
Exact Name of Entity: __________________________________________________________
□ Certified Copies of all Documents on File ($10 per document)
□ Plain Copies of all Documents on File ($5 per document)
□Certified Copy of _____________________________________________________ ($10 per document)
(specify document)
□ Plain Copy of ________________________________________________________ ($5 per document)
(specify document)
□ Certificate of Status - Long Form ($25 per document)
□ Certificate of Status - Short Form ($25 per document)
Method of Delivery of Filing Receipt or Other Document
All documents will be returned to the email address listed above with the exception of certified and
uncertified copies filed before July 1990.
DOS-2183-f (04/22)
DOS-1239-f (Rev. 12/22)
Page 1 of 2
New York State
Department of State
DIVISION OF CORPORATIONS,
STATE RECORDS AND
UNIFORM COMMERCIAL CODE
One Commerce Plaza
99 Washington Ave.
Albany, NY 12231-0001
https://dos.ny.gov
CERTIFICATE OF INCORPORATION
OF
(Insert Name of Corporation)
Under Section 402 of the Business Corporation Law
FIRST:
The name of the corporation is:
.
SECOND:
The purpose of the corporation is to engage in any lawful act or activity for which
a corporation may be organized under the Business Corporation Law. The corporation is not
formed to engage in any act or activity requiring the consent or approval of any state official,
department, board, agency or other body without such consent or approval first being obtained.
THIRD: The county, within this state, in which the office of the corporation is to be located
is: .
FOURTH: The corporation shall have 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 corporation upon whom process
against the corporation may be served.
The post office address to which the Secretary of State shall mail a copy of any process
against the corporation served upon the Secretary of State by personal delivery is:
(Optional) The email address to which the Secretary of State shall email a notice of the
fact that process against the corporation has been served electronically upon the Secretary
of State is:
X
(Print or Type Name of Incorporator) (Signature of Incorporator)
(Address of Incorporator)
(City, State, Zip Code)
DOS-1239-f (Rev. 12/22)
Page 2 of 2
CERTIFICATE OF INCORPORATION
OF
(Insert Corporate Name)
Under Section 402 of the Business Corporation 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 a certificate of incorporation for a business
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. The Department of State recommends that legal documents be prepared under the guidance of an attorney.
3. The fee for filing a certificate of incorporation is $125. Preferred payment methods include money order, Visa or
Mastercard. Money orders should be made payable to the Department of State.
4. The incorporator must be a natural person, not a corporation or other business entity.
5. The filer may not be the corporation being formed.
For DOS use only
