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

Certificate of Withdrawal of Assumed Name

CWA

_____________________________________________________________________________
This certifies that the assumed name of ___________________________________________________________________________________
[Assumed name under which the business is being conducted]

has been discontinued by ___________________________________________________________________________________
[Real name - KRS 365.015(1)]

which is the "real name" of

[YOU MUST CHECK ONE] ______a Foreign General Partnership ______a Foreign Limited Liability Partnership ______a Foreign Limited Partnership ______a Foreign Business Trust ______a Foreign Corporation ______a Foreign Limited Liability Company

_____a Domestic General Partnership _____a Domestic Limited Liability Partnership _____a Domestic Limited Partnership _____a Domestic Business Trust _____a Domestic Corporation _____a Domestic Limited Liability Company _____a Joint Venture

organized and existing in the state or country of __________________________, and whose address is ___________________________________________________________________________________.
Street address, if any City State Zip Code

The certificate of assumed name was filed with the Secretary of State on ________________________.

The certificate of withdrawal of assumed name is executed by ____________________________________
Signature

_______________________________
Signature

____________________________________
Print or type name and title

_______________________________
Print or type name and title

____________________________________
Date

_______________________________
Date

CWA (06/07)

(See attached sheet for instructions)

Certificate of Withdrawal of Assumed Name Filing Instructions ASSUMED BUSINESS NAME AND DATE OF FILING The certificate must state the assumed name as filed with the Secretary of State. Give the date the certificate of assumed name was filed with the Secretary of State. NOTE: A separate certificate must be filed for each assumed name that is being withdrawn by the business entity. WHO MAY SIGN The Certificate of Withdrawal of Assumed Name must be signed by: · at least one partner authorized to do so by the partners of a Domestic or Foreign General Partnership (also includes a Joint Venture); · at least one partner authorized to do so by the partners of a Domestic or Foreign Registered Limited Liability Partnership; · a general partner of a Domestic of Foreign Limited Partnership; · the trustees of a Domestic or Foreign Business Trust; · any person authorized to act for the Domestic or Foreign Corporation. · a member or manager authorized to act for the Domestic of Foreign Limited Liability Company. NUMBER OF COPIES Submit the original signed Certificate and at least one exact or conformed copy (may be a photocopy). All file-stamped copies will be returned to you as evidence of filing. One file-stamped copy must then be filed with the county clerk of the county where the entity is deemed a resident for the purposes of and under the provisions of KRS Chapter 355. FILING FEE AND MAILING ADDRESS The filing fee is $20.00. Your check should be made payable to the "Kentucky State Treasurer" 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, please call (502) 564-2848, press 2, and then press 5 or try our web site.