COMMONWEALTH OF KENTUCKY
TREY GRAYSON
SECRETARY OF STATE
APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY
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 business corporation (KRS 271B).
a nonprofit corporation (KRS 273).
a professional service corporation (KRS 274).
2. ______________________________________________________________________________________
(Name of corporation or fictitious name adopted for use in Kentucky)
is a corporation organized and existing under the laws of the state or country of _______________________
and received authority to transact business in Kentucky on _______________________________________.
3. The corporation’s name in the state or country of incorporation has been changed to
______________________________________________________________________________________.
The name of the corporation to be used in Kentucky is
______________________________________________________________________________________.
(If "real name" is unavailable for use)
4. The corporation’s period of duration has been changed to________________________________________.
5. The corporation's state or country of incorporation has been changed to_____________________________.
6. A certificate of existence duly authenticated by the Secretary of State accompanies this application.
7. This application will be effective upon filing, unless a delayed effective date and/or time is specified:
___________________________________
(Delayed effective date and/or time)
)
_____________________________________________
Signature
_____________________________________________
Type or Print Name & Title
Date:____________________________, 20__________
SSC-102 (2/98)
(See attached page for instructions)