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

CRN

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Pursuant to the provisions of KRS 275 & 362 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: ________________________________________

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

Instructions: Submit this form with one (1) exact or conformed copy. The filing fee is $15.00 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 partnership name or a limited liability company name.

CRN (04/09)