Form Fbt-101 - Statement Of Change Of Registered Office Or Registered Agent Or Both - Kentucky Secretary Of State

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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 KRS Chapter 386, the undersigned hereby applies to change the registered office or
registered agent, or both on behalf of the business trust named below and for that purpose submits the following
statements:
1. The name of the business trust is
_____________________________________________________________________________________________.
(Exact name of business trust)
2. The state or country or establishment is _____________________________________________________________.
3. The street address of the current registered office on file with the Secretary of State is
_____________________________________________________________________________________________.
Street
City/State
Zip Code
4. The street address of the registered office is hereby changed to
_____________________________________________________________________________________________.
Street
City/State
Zip Code
5. The name of the current registered agent on file with the Secretary of State is
_____________________________________________________________________________________________.
6. The name of the registered agent is hereby changed to
______________________________________________________________________________________________.
7. The street address of the registered office and the business office of the registered agent, as changed, is identical.
_____________________________________________
Signature
_____________________________________________
Type or Print Name & Title
Date: _____________________________, 20_________
I, ______________________________________ consent to serve as the registered agent on behalf of the business trust.
Type or print name of registered agent
_______________________________________________
Signature of Registered Agent
_______________________________________________
Type or Print Name & Title, if applicable
FBT-101 (2/98)
(See attached sheet for instructions)

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