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/
Certificate of Withdrawal of Foreign Business Trust
WBT
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Pursuant to the provisions of KRS Chapter 386 the undersigned hereby cancels the registration on behalf of the business trust named below and for that purpose submits the following statements: 1. The name of the business trust is _______________________________________________________ 2. The state or country of organization is ___________________________________________________ 3. The date the business trust was authorized to do business in Kentucky is _______________________ 4. The Secretary of State may forward to the business trust at the following address any process served on the Secretary of State: ____________________________________________________________________________________
Address City State Zip Code
5. The business trust surrenders its authority to transact business in the Commonwealth. 6. The business trust revokes the authority of its registered agent to accept service of process on its behalf and appoints the Secretary of State as its agent for service of process in any proceeding based on a cause of action arising during the time it was authorized to transact business in the Commonwealth. The business trust shall notify the Secretary of State in the future of any change in its mailing address.
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Signature of Trustee _______________________________________________________ Type or Print Name & Title
Date:_____________________________,20____
Please submit one original and one exact or conformed copy. The filing fee is $15.00. Please make your check payable to the "Kentucky State Treasurer". Mailing Address Trey Grayson Secretary of State P. O. Box 718 Frankfort, KY 40602-0718 Our home page address is http://www.sos.ky.gov. Our phone number is 502-564-2848 WBT (06/07) Office Location Room 154, Capitol Building 700 Capital Avenue Frankfort, KY 40601