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)
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
(Corporation Name)
Under Section 402 of the Not-for-Profit Corporation Law
FIRST: The name of the corporation is:
.
SECOND: The corporation is a corporation as defined in subparagraph (5) of paragraph (a) of
Section 102 of the Not-for-Profit Corporation Law.
THIRD: (Select all that apply)
The purpose(s) for which the corporation is formed is:
any purpose for which corporations may be organized under the Not-for-Profit Corporation Law
as a charitable corporation.
any purpose for which corporations may be organized under the Not-for-Profit Corporation Law
as a non-charitable corporation.
any purpose for which corporations may be organized under the Not-for-Profit Corporation Law
as a charitable corporation or as a non-charitable corporation. (Note: Checking this box results in the
corporation being categorized as a charitable corporation in paragraph FIFTH.)
the following specific purpose(s):
DOS-1511-f (Rev. 12/22) Page 1 of 4
FOURTH: (Check the appropriate statement)
The corporation is not formed to engage in any activity or for any purpose requiring consent
or approval of any state official, department, board, agency or other body. No consent or
approval is required.
The corporation is formed to engage in an activity or for a purpose requiring consent or
approval of a state official, department, board, agency or other body. Such consent or approval
is attached.
FIFTH: The corporation is a: charitable corporation non-charitable corporation under
Section 201 of the Not-for-Profit Corporation Law.
SIXTH: The office of the corporation is to be located in the County of ,
State of New York.
SEVENTH: The names and addresses of the initial directors of the corporation are:
(A minimum of three is required)
N
ame:
A
ddress:
N
ame:
A
ddress:
Name:
A
ddress:
EIGHTH: 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:
.
DOS-1511-f (Rev. 12/22) Page 2 of 4
NINTH: (Optional – Corporations seeking tax exempt status may include language required by the
Internal Revenue Service in this paragraph. See Not-for-Profit Incorporation Instructions.)
The following language relates to the corporation’s tax exempt status and is not a statement of purposes
and powers. Consequently, this language does not expand or alter the corporation’s purposes or powers
set forth in paragraph THIRD.
DOS-1511-f (Rev. 12/22) Page 3 of 4
NAME, SIGNATURE & ADDRESS OF INCORPORATOR:
X
(Print or Type Name of Incorporator) (Signature of Incorporator)
(Address of Incorporator)
(City, State, Zip Code)
CERTIFICATE OF INCORPORATION
OF
(Corporation Name)
Under Section 402 of the Not-for-Profit Corporation Law
Filer’s Name and Mailing Address:
Name:
Company, if Applicable:
Mailing Address:
City, State and Zip Code:
NOTES:
1. §301 of the Not-for-Profit Corporation Law requires that the name contain “Incorporated” or “Inc.” or one of the
other words or abbreviations indicative of corporate character unless the corporation qualifies for one of the
exceptions in §301.
2. This sample form is provided by the New York State Department of State for filing a certificate of incorporation.
3. This form is designed to satisfy the minimum filing requirements pursuant to the Not-for-Profit Corporation Law.
The Department of State will accept any other form which complies with the applicable statutory provisions.
4. The Department of State recommends that this legal document be prepared under the guidance of an attorney.
5. The Department of State does not provide legal, accounting or tax advice.
6. This certificate must be submitted with a $75 filing fee made payable to the Department of State.
For DOS use only
DOS-1511-f (Rev. 12/22) Page 4 of 4
