NY PLLC and PC Guide

Guide to Filling Out the NY PLLC/PC Affidavit Form

If you’re forming a Professional Limited Liability Company (PLLC) or a Professional Corporation (PC) in New York, the New York State Education Department (NYSED) requires you to complete an affidavit form.

Here’s a step-by-step guide prepared by our team of attorneys to help you fill out the affidavit correctly.

Before You Start

You must be a licensed professional in New York (e.g., doctor, nurse practitioner, dentist, etc.).
You can form either a PLLC or a PC, depending on your preference.
After forming the entity, your accountant can help you file an S-corporation tax election, if desired.
If you choose a PLLC, New York also requires a publication step that usually costs $500–$1,000. We can take care of this step for you–just let us know.

Step-by-Step Instructions

Step 1

Personal Information

Your Name: Enter your full legal name.
Name of Profession: Be specific (e.g., “Medicine,” “Nurse Practitioner in Family Health,” “Dentistry”). See note below on naming conventions.

Step 2

License Details

License Number: Enter your official license number from NYSED.
Date of License: Use the date your license was issued (i.e., not the date it was last renewed but rather, the date that it was first issued).

Step 3

Identification Info

Date of Birth: Enter your birthdate in MM/DD/YYYY format.
Home Address: Provide your current residential address (not your business address).

Step 4

Ownership Info

Check whether you’re an Owner (for PLLC) or Shareholder (for PC). Enter your proposed business name exactly as you want it to appear. For example: Amy Smith NP in Acute Care NY PLLC

Note on Naming: NYSED is very strict about naming.

A nurse practitioner might use: “Amy Smith NP in Acute Care NY PLLC”
A physician might use: “Amy Smith Medical NY PLLC”

Any names that imply any promises or outcomes are rejected. For example, something like “complete wellness” or “best med spa” will not get approved.

Step 5

Acknowledging NY Rules

By signing this form, you’re agreeing to NY rules that prohibit:

Fee splitting
Profit sharing with non-professionals
Partnerships with non-professional entities (unless permitted by law)

Step 6

Business Relationships

Entity Name: Enter the name from Section 4 again.
Choose one:

Subitem 2.1
Subitem 2.2

Option A:No affiliations with any other companies.
Option B:You do have affiliations. In this case, list:
The name of the affiliated company
The type of relationship (e.g., shared ownership, management agreement)

Step 7

Sign & Notarize

Only sign this form in front of a notary. You can use a bank notary or go online to www.notarize.com. Once notarized, save the form as a PDF.

Step 8

Final Step

Email the completed PDF form to us so we can finalize your filing!

Download Affidavit Template