Form Ssc-107 - Statement Of Change Of Registered Office Or Registered Agent Or Both - Secretary Of State, Commonwealth Of Kentucky

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COMMONWEALTH OF KENTUCKY
TREY GRAYSON
SECRETARY OF STATE
STATEMENT OF CHANGE OF REGISTERED OFFICE
OR REGISTERED AGENT OR BOTH
Pursuant to the provisions of Chapters 271B or 273 of the Kentucky Revised Statutes, the undersigned hereby
applies to change the registered office or registered agent, or both on behalf of
__________________________________________________________________________________________________
(Exact name of corporation)
which is organized in the state of ___________________, and for that purpose submits the following statements:
1. Name of current registered agent
2. Registered agent is hereby changed to
3. Address of current registered office
4. Registered office is hereby changed to
The street address of the registered office and the business office of the registered agent, as changed, will be identical.
5. Signature of officer or chairman of the board
6. Consent of Registered Agent
I, ___________________________________________
Signature and Title
(Print or type name)
consent to serve as the registered agent on behalf of the
corporation.
Type or Print Name and Title
Dated: ___________________________________________
Signature of Registered Agent
Type or Print Name & Title, if applicable
SSC-107 (7/98)
(See attached sheet for instructions)

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