C
K
OMMONWEALTH OF
ENTUCKY
T
G
, S
S
REY
RAYSON
ECRETARY OF
TATE
__________________________________________________________________________________________________________________________
Division of Corporations
Amended Certificate of Authority
FLA
Business Filings
(Foreign Limited Liability Company)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
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 of the limited liability company named below and, for that purpose, submits the following
statements:
1. The name of the limited liability company is_________________________________________________________________.
(Name of limited liability company or fictitious name adopted for use in Kentucky)
2. The limited liability company is organized and existing under the laws of the state or country of ________________________.
3. The limited liability company received authority to transact business in Kentucky on ________________________________.
4. The limited liability company's name in its state or country of organization has been changed to
_____________________________________________________________________________________________________.
5. The name of the limited liability company to be used in Kentucky is:
_____________________________________________________________________________________________________.
(If real name is unavailable, use the fictitious name adopted for use in Kentucky.)
6. The latest date on which the limited liability company is to dissolve has been changed to _____________________________.
7. The limited liability company's state or country of organization has been changed to _________________________________.
8. 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)
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.
I declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct.
______________________________________________________________________________________________
Signature of Member, Manager or Authorized Party
Printed Name & Title
Date
(08/10)