Request For Apostille Or Authentication Form - Commonwealth Of Kentucky Secretary Of State

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C
K
OMMONWEALTH OF
ENTUCKY
.
, S
S
ELAINE N
WALKER
ECRETARY OF
TATE
_________________________________________________________________________________________________________________________
Division of Corporations
Request for Apostille or Authentication
Business Records
PO Box 718
Frankfort, KY 40602
(502) 564-3490
(502) 564-5687 (fax)
__________________________________________________________________________________________
This document is being certified for use in the country of: _________________________________________________
Number of documents enclosed needing certification: ______________________________________________________
Total amount enclosed ($5.00 per Apostille/Authentication):_________________________________________________
Checks should be made payable to the Kentucky State Treasurer.
Requesters Contact Information:
_________________________________________________________________________________________________
Name (Please print)
_________________________________________________________________________________________________________________________
Mailing Address
________________________________________________________________________________ ________________________ ________________
City
State
Zip Code
_________________________________________________________________________________________________________________________
Phone Number
Where Apostilled or Authenticated Documents Should Be Mailed:
_________________________________________________________________________________________________
Name (Please print)
_________________________________________________________________________________________________________________________
Mailing Address
_______________________________________________________________________________ ________________________ _________________
City
State
Zip Code
_________________________________________________________________________________________________________________________
Phone Number
Must check one:
___ The attached document is county clerk certified.
___ The attached document is certified by the current state registrar (from Vital Statistics).
You must enclose the document(s) with this request.
(01/11)

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