Kentucky Secretary of State TREY GRAYSON
Division of Corporations BUSINESS FILINGS P.O. Box 718 Frankfort, KY 40602 (502) 564-2848 http://www.sos.ky.gov/
Statement of Consent of Registered Agent
Pursuant to the provisions of KRS Chapter 271B, 273, 275,362 or 386, the undersigned hereby consents to act as registered agent on behalf of the business entity named below and for that purpose submits the following statements:
The business entity is
a corporation (KRS 271B or KRS 273) a limited liability company (KRS 275) a limited partnership (KRS 362) a limited liability partnership (KRS 362) a business trust (KRS 386)
The name of the business entity is _____________________________________________________________________________. The state or country of incorporation, organization or formation is _________________________. The name of the initial registered agent is _____________________________________________________________________________. The street address of the registered office address in Kentucky is _____________________________________________________________________________.
Street City State Zip Code
Signature of registered agent
Type or Print Name & Title, if applicable
Date: ______________________________, 20_______
(See attached sheet for instructions)
Statement of Consent Registered Agent Filing Instructions
NAME OF BUSINESS ENTITY Use the exact name of the business entity as stated in its Articles of Incorporation, Articles of Organization, Certificate of Limited Partnership, Statement of Qualification or Business Trust. WHO MAY SIGN · If the registered agent is an individual resident of this state, the individual must sign the statement. · If registered agent is a corporation, an officer or the chairman of the board of directors must sign on behalf of the corporation. · If the registered agent is a limited liability company and management of the company is vested in one or more managers, a manager must sign on behalf of the limited liability company. If management of the company is vested in its members, a member must sign. · If the registered agent is a limited partnership, a general partner must sign on behalf of the limited partnership. · If the registered agent is a limited liability partnership the statement shall be executed by a partner or other person authorized by chapter 362. · If the registered agent is a business trust the statement shall be signed by a trustee. · The representative signing the statement of consent on behalf of the business entity acting as agent must designate the title or the capacity in which he or she signs. NUMBER OF COPIES The statement of consent of registered agent must accompany Articles of Incorporation, Articles of Organization or Certificate of Limited Partnership. Submit the original signed statement and two exact or conformed copies. (May be photocopies) MAILING ADDRESS Trey Grayson Secretary of State P. O. Box 718 Frankfort, KY 40602-0718 OFFICE LOCATION Room 154, Capitol Building 700 Capital Avenue Frankfort, KY 40601
WEB SITE ADDRESS Our home page address is www.sos.ky.gov 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 further information, call (502) 564-2848, press 2, and then press 3 or try our web site.