Form Aan - Amended Certificate Of Assumed Name (Domestic Or Foreign Business Entity)

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C
K
OMMONWEALTH OF
ENTUCKY
E
N. W
, S
S
LAINE
ALKER
ECRETARY OF
TATE
_________________________________________________________________________________________________________________________
Division of Business Filings
Amended Certificate of Assumed Name
AAN
Business Filings
(Domestic or Foreign Business Entity)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
__________________________________________________________________________________________
Pursuant to the provisions of KRS 365, the undersigned applies to amend the certificate of assumed name and, for that
purpose, submits the following statement:
1. The assumed name is____________________________________________________________________________.
(The name must be identical to the name on record with the Secretary of State.)
2. The certificate of assumed name was filed with the Secretary of State on: __________________________________.
3 The current principal office address (if any) is:
____________________________________________ __________________________ ____________ _____________.
Street Address or Post Office Box Numbers
City
State
Zip
4. The principal office address is hereby changed to:
____________________________________________ __________________________ ____________ _____________.
Street Address or Post Office Box Numbers
City
State
Zip
5. This application will be effective upon filing, unless a delayed effective date and/or time is provided. The effective date
or the delayed effective date cannot be prior to the date the application is filed. The date and/or time is______________.
(Delayed effective date
and/or time)
6. The changes in the identity of the partners are as follows: ________________________________________________
________________________________________________________________________________________________.
I declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct.
__________________________________ ____________________________________ _____________________ _______________
Signature of Applicant
Printed Name
Title
Date
(04/11)

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