Kentucky Secretary of State
T
G
REY
RAYSON
___________________________________________________________________________________________________________
Division of Corporations
Application for Amended
FLA
B
F
USINESS
ILINGS
Certificate of Authority
P.O. Box 718
Frankfort, KY 40602
(502) 564-2848
_______________________________________________________________________________
Pursuant to the provisions of KRS Chapter 275, the undersigned hereby applies for an amended certificate
of authority to transact business in Kentucky on behalf the limited liability company named below and for
that purpose submits the following statements:
1.____________________________________________________________________________
(Name of limited liability company or fictitious name adopted for use in Kentucky)
is a limited liability company organized and existing under the laws of the state or country of
__________________________________, and received authority to transact business in Kentucky on
____________________________.
2. The limited liability company's name in its state or country of organization has been changed to
_____________________________________________________________________________________.
The name of the limited liability company to be used in Kentucky is
_____________________________________________________________________________________.
(if "real name" is unavailable for use)
3. The latest date on which the limited liability company is to dissolve has been changed to
_____________________________________________________________________________________.
4. The limited liability company's state or country of organization has been changed to
_____________________________________________________________________________________.
5. This application will be effective upon filing, unless a delayed effective date and/or time is
specified:___________________________________
(Delayed effective date and/or time)
I certify that, as of the date of filing this amended certificate of authority, the above-named limited liability
company validly exists as a limited liability company under the laws of the jurisdiction of its formation.
____________________________________________
Signature
____________________________________________
Type or Print Name & Title
Date:______________________________, 20_______
SLL-903 (06/07)
(See attached sheet for instructions)