Kentucky Secretary of State
T
G
REY
RAYSON
_____________________________________________________________________________________________________________
Division of Corporations
Application for Certificate of
FNT
B
F
USINESS
ILINGS
Authority of Foreign Business Trust
P.O. Box 718
Frankfort, KY 40602
(502) 564-2848
_____________________________________________________________________________________________________________
Pursuant to the provisions of KRS Chapter 386, the undersigned hereby applies for a certificate of
authority on behalf of the business trust named below and for that purpose states:
1. The name of the business trust is_____________________________________________________
2. _________________________is the state or country whose law it is organized.
3. ____________is the date of organization. If the trust has a specific date of dissolution, the date upon
which it is to dissolve._______________________________________________________________
4. The name of the registered agent is ____________________________________________________
and the street address of the registered office in Kentucky is
__________________________________________________________________________________
Street
City
State
Zip Code
5. The address of the principal office is
__________________________________________________________________________________
Address
City
State
Zip Code
6. The name and usual business address of its current trustees is
___________________________________
_____________________________________
Name
Address
____________________________________________________
________________________________________________________
Name
Address
7. As of the date of filing, the business trust validly exists as a business trust under the laws of the
jurisdiction of its organization.
______________________________________
Signature & Date
_________________________________________________________
Type or Print Name & Title
I, ___________________________________, consent to serve as registered agent on behalf of the trust.
__________________________________________________________________
Signature of Agent
__________________________________________________________________
Type or Print Name & Title
FNT (01/2008)
(See attached instructions)