Form Fca - Amended Certificate Of Authority
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1C
K
OMMONWEALTH OF
ENTUCKY
T
G
, S
S
REY
RAYSON
ECRETARY OF
TATE
____________________________________________________________________________________________________________________________
Division of Corporations
Amended Certificate of Authority
FCA
Business Filings
(Foreign Corporation)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
__________________________________________________________________________________________
Pursuant to the provisions of KRS Chapter 271B, 273 or 274, the undersigned hereby applies for an amended certificate of
authority on behalf of the corporation named below and, for that purpose, submits the following statements:
1. The corporation is:
a profit corporation (KRS 271B).
a nonprofit corporation (KRS 273).
a professional service corporation (KRS 274).
2. The name of the company is:
___________________________________________________________________________________________________.
(The name must be identical to the name on record with the Secretary of State.)
3. It is a corporation organized and existing under the laws of the state or country of _______________________________.
4. The corporation received authority to transact business in Kentucky on ________________________________________.
5. The corporation’s name in the state or country of incorporation has been changed to
___________________________________________________________________________________________________.
6. The name of the corporation to be used in Kentucky is
___________________________________________________________________________________________________.
(If real name is unavailable, use the fictitious name adopted for use in Kentucky.)
7. The corporation’s period of duration has been changed to ___________________________________________________.
8. The corporation's state or country of incorporation has been changed to________________________________________.
9. A certificate of existence duly authenticated by the Secretary of State accompanies this application.
10. This application will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date or
the delayed effective date cannot be prior to the date the application is filed. The date and/or time is ___________________.
(Delayed effective date
and/or time)
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)
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