Free Kentucky Secretary of State - Kentucky

Kentucky Secretary of State TREY GRAYSON
_____________________________________________________________________________________________________________

Division of Corporations BUSINESS FILINGS P.O. Box 718 Frankfort, KY 40602 (502) 564-3490 http://www.sos.ky.gov/
This certifies that the assumed name of:

Amended Certificate of Assumed Name

AAN

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________ [Name of record with the Secretary of State]

has been amended to revise the real name of the partners or business organization holding the assumed name to:
_____________________________________________________________________________________________________________ [Real name ­ KRS 365.015(1)]

The certificate of assumed name was filed with the Secretary of State on: ______________________________ The current principal office address is:
______________________________________________________________________________________________________________ Street Address, if any City State Zip Code

The principal office address is hereby changed to: _________________________________________________________________________________________
Street Address, if any City State Zip Code

The certificate is effective upon filing unless a delayed effective date and/or time is specified: _______________ The changes in the identity of the partners are as follows: ____________________________________________ __________________________________________________________________________________________

The amended certificate of assumed name is executed by:
_____________________________________________________ (Signature) _____________________________________________________ (Type or Print Name) _____________________________________________________ (Signature) _____________________________________________________ (Type or Print Name)

_______________________________________________ Date

_______________________________________________ Date

Instructions: Submit this form with one (1) exact or conformed copy. The filing fee is $20.00. Please make your check payable to the "Kentucky State Treasurer".