C
K
OMMONWEALTH OF
ENTUCKY
T
G
, S
S
REY
RAYSON
ECRETARY OF
TATE
____________________________________________________________________________________________________________________________
Division of Corporations
Registration or Renewal of Corporate Name
FRG
Business Filings
(Foreign Business Entity)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
____________________________________________________________________________________________
Pursuant to the provisions of KRS Chapter 271B, 273 and 274, the undersigned hereby applies for registration or renewal of
corporate name on behalf of the corporation named below and, for that purpose, submits the following statements:
1. The activity request is:
Registration
Renewal
2. The name of the corporation is________________________________________________________________________.
3. The mailing address of the corporation is:
___________________________________________________________________________________________________
Street Address or Post Office Box Numbers
City
State
Zip Code
4. The state or country of incorporation is _________________________________________________________________.
5. The date of incorporation is __________________________________________________________________________.
6. The nature of the business of the corporation is ___________________________________________________________
(Please print brief description)
___________________________________________________________________________________________________
___________________________________________________________________________________________________
7. A certificate of existence duly authenticated by the Secretary of State accompanies this application.
I declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct.
____________________________________________________________________________________________________
Signature of Officer or Chairman of the Board
Printed Name & Title
Date
(09/09)