PERMITTEE REGISTRATION APPLICATION - New …
Rev. 10/6/15LEGAL ENTITY TYPE: (CHECK ONLY ONE)Page 1 of 3____ CORPORATION, LLC OR LLP (COMPLETE SECTIONS 1A, 2 TO 5)____ PARTNERSHIP (COMPLETE SECTIONS 1B, 2 TO 5)_____ JOINT VENTURE (COMPLETE SECTIONS 1C, 2 TO 5) ____ SOLE PROPRIETORSHIP (COMPLETE SECTIONS 1D, 2 TO 5)Field with an asterisk (*) next to it is mandatory. NYS Department of State Number*:________________________________ ________________________________________ ____ Tel #*:(__________)____________-____________ ____(__________)______________-_________ _____ NY State Department of State (NYS DOS) Additional Information NYS DOS Process Address: (Address to which DOS will mail process if accepted on behalf of the entity) Index Number (Provided by County Clerk Office):________________________________ ___________________________________ Tel #*:(__________)____________-____________ ____(__________)______________-_________ _____ Tel #*:(__________)____________-____________ ____(__________)______________-_________ _____ Tel #*:(__________)____________-____________ ____(__________)______________-_________ _____Page 1 of 3 24-Hour Emergency Telephone Number* (Must be able to make immediate contact).
(Address to which DOS will mail process if accepted on behalf of the entity)
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