Kentucky Secretary of State
T
G
REY
RAYSON
_________________________________________________________________________________________________
Division of Corporations
Application for Registration or
FRG
B
F
USINESS
ILINGS
Renewal of Corporate Name
P.O. Box 718
Frankfort, KY 40602
(502) 564-2848
________________________________________________________________________
Pursuant to the provisions of KRS Chapter 271B or 273, 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:
Registration
Renewal
(CHECK ONE)
2. The name of the corporation is
_____________________________________________________________________________.
3. The state or country of incorporation is
_____________________________________________________________________________.
4. The date of incorporation is
_____________________________________________________________________________.
5. The nature of the business of the corporation is
_____________________________________________________________________________
(Brief Description)
_____________________________________________________________________________.
6. A certificate of existence duly authenticated by the Secretary of State accompanies this
application.
______________________________________
Signature
______________________________________
Type or Print Name & Title
______________________________________
Street Address
______________________________________
City
State
Zip Code
Date: ________________________, 20_______
FRG (06/07)
(See attached sheet for instructions)