Free Kentucky Secretary of State - Kentucky

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Date: June 27, 2007
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State: Kentucky
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Kentucky Secretary of State TREY GRAYSON

Division of Corporations BUSINESS FILINGS P.O. Box 718 Frankfort, KY 40602 (502) 564-2848

Statement of Change of Registered Office or Registered Agent or Both


Pursuant to the provisions of Chapter 271B,273,275, or 362 of the Kentucky Revised Statutes, the undersigned hereby applies to change the registered office of registered agent, or both on behalf of

(Exact name of entity)

which is organized in the state of ______________, and for that purpose submits the following statements: 1. Name of current registered agent 2. Registered agent is hereby changed to



3. Address of current registered office _________________________________ _________________________________ _________________________________ _________________________________

4. Registered office is hereby changed to _________________________________ _________________________________ _________________________________ _________________________________

The Street address of the registered office and the business office of the registered agent, as changed, will be identical.

5. Signature of officer or chairman of the board member, manager, or partner

6. Consent of Registered Agent

Signature and title

I consent to serve as the registered agent on behalf of this entity

Type or print name and title

Signature of registered agent



RAC (06/07)

(See attached sheet for instructions)

Statement of Change of Registered Office or Registered Agent or Both Filing Instructions
NUMBER OF COPIES Submit the original signed statement and two exact or conformed copies. (May be photocopies). Two file-stamped copies will be returned to the entity as evidence of filing. One file-stamped copy must then be filed with the county clerk of the county in which the entity registered office is situated. FILING FEES The filing fee for a business corporation (domestic or foreign) or limited liability company (domestic or foreign), limited partnership (domestic or foreign) or limited liability partnership (domestic or foreign) is $10.00 The filing fee for a nonprofit corporation (domestic or foreign) is $5.00.

Your check should be made payable to "Kentucky State Treasurer."
MAILING ADDRESS Trey Grayson Secretary of State P. O. Box 718 Frankfort, KY 40602-0718 WEB SITE ADDRESS Our home page address is Click on "On Line Business Database" for information on status of all business entities in Kentucky. Forms are also available on our web site. For more information, please call (502) 564-2848, press 2, and then press 4 or try our web site. NOTE: The corporation must be in "good standing" upon the records of the Secretary of State before current statements or documents can be filed (30 KAR 1:010). OFFICE LOCATION Room 154, Capitol Building 700 Capital Avenue Frankfort, KY 40601