C
K
OMMONWEALTH OF
ENTUCKY
T
G
, S
S
REY
RAYSON
ECRETARY OF
TATE
____________________________________________________________________________________________________________
Division of Corporations
Statement of Change of Registered Office
RAC
Business Filings
PO Box 718
or Registered Agent or Both
Frankfort, KY 40602
(502) 564-3490
________________________________________________________________________________
Pursuant to the provisions of KRS Chapter 271B, 273, 275, or 362, the undersigned hereby applies to
change the registered office of registered agent, or both on behalf of:
_____________________________________________________________________________
(The name must be identical to the name on record with the Secretary of State.)
which is organized in the state of ______________, and for that purpose submits the following statements:
1. Name of current registered agent:
2. Registered agent is hereby changed to:
__________________________________
___________________________________
3. Address of current registered office:
4. Registered office is hereby changed to:
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
The street address of the registered office and the business office of the registered agent, as changed, will be identical.
5. Signature of officer, chairman of the board
6. Consent of registered agent
member, manager, or partner
_________________________________
I consent to serve as the registered agent on behalf of
Signature and title
this entity:
_________________________________
_________________________________
Type or print name and title
Signature of registered agent
_________________________________
_________________________________
Date
Date
(09/09)