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) 564-2848 http://www.sos.ky.gov/

Statement of Resignation of Registered Agent

SRA

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I, _______________________________________________________________________do hereby
_________________resign as registered agent, and _________________discontinue the registered office address on behalf of _____________________________________________________________________
Exact name of entity

_________________a corporation (KRS 271B, KRS 273) _________________a limited liability company (KRS 275) _________________a limited partnership (KRS 362) _________________a limited liability partnership (KRS 362) _________________a business trust (KRS 386) organized and existing in the state or country of ________________________________________. The agency appointment shall be terminated and the registered office discontinued, if so provided, on the 31st day after the date on which the statement if filed. _________________________________________
Signature of Resigning Agent

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Print or Type Name

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Street Address

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City State Zip Code

Submit one originally signed and two exact or conformed copies. One filed stamped copy will be returned to the resigning agent and one copy will be mailed to the business entity at its principal office address. Mailing Address: Trey Grayson ­ Secretary of State ­ P. O. Box 718 -Frankfort, KY 40602

SRA (06/2007)