Form Ccr - Cancellation Of Reserved Name - 2012 printable pdf download

Form Ccr - Cancellation Of Reserved Name - 2012

OMMONWEALTH OF

ENTUCKY

, S

LISON

UNDERGAN

RIMES

ECRETARY OF

TATE

_________________________________________________________________________________________________________________________

Division of Business Filings

Cancellation of Reserved Name

CCR

Business Filings

(Domestic and Foreign Entity)

PO Box 718

Frankfort, KY 40602

(502) 564-3490

__________________________________________________________________________________________

Pursuant to the provisions of KRS 14A, KRS 271B, 273, 275, 362 and 386 the undersigned applies to cancel a reserved

name and, for that purpose, submits the following statement:

1. The name reserved was _________________________________________________________________________.

(Name must be identical to the name on record with the Secretary of State.)

2. The name was reserved by_______________________________________________________________________.

3. The date the name reservation was filed with the Office of the Secretary of State_____________________________.

4. The mailing address of the applicant:

____________________________________________ __________________________ ____________ _____________.

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)

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

(01/12)

Form Ccr - Cancellation Of Reserved Name - 2012