Free Kentucky Secretary of State - Kentucky

Kentucky Secretary of State TREY GRAYSON
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Division of Corporations BUSINESS FILINGS P.O. Box 718 Frankfort, KY 40602 (502) 564-3490 http://www.sos.ky.gov/

Notice of Cancellation of Reserved Name

CCR

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Pursuant o the provisions of KRS 271B & 273 the undersigned applies to cancel a reserved name and for that purpose submits the following statement:

1. The name that was reserved: _____________________________________________________________

2. The name was reserved by: ______________________________________________________________

3. The date the name reservation was filed with the Secretary of State: ______________________________ (Day/Month/Year)

Executed by the applicant on: ________________________________

________________________________________________________ (Signature) ________________________________________________________ (Print or Type Name and Title) ________________________________________________________ (Street Address) ________________________________________________________ (City, State & Zip)

Instructions: Submit this form with one (1) exact or conformed copy. The filing fee is $10.00. Please make check payable to the "Kentucky State Treasurer". All information must be completed or this document will not be accepted for filing. This form is to cancel a reservation, reserving a corporate name.

CCR (02/09)