Form Fqc - Cancellation Of Foreign Statement Of Qualification (Foreign Limited Liability Partnership) Page 3

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FILING INSTRUCTIONS

CANCELLATION OF STATEMENT OF FOREIGN QUALIFICATION NAME

NAME

Use the exact name of the business entity as registered on file with the Office of the Secretary of State.

DATE OF FILING

Give the date the limited liability partnership name was filed with the Secretary of State.

EFFECTIVE DATE AND TIME

The document will be effective on the date and time of filing, unless a delayed effective date and/or time is specified. A delayed effective date may not

be later than the 90

day after the date of filing.

WHO MAY SIGN

The document must be signed by a partner or other authorized party.

NUMBER OF COPIES

When filing online with the FastTrack system, no copies are required. If filing via mail or in person, one exact or conformed copy of the documents with

the filing fee must be submitted to the address below. To make a copy of the filing for delivery to the local county clerk’s office, visit and

print a copy from the organization search tool.

DOCUMENT DELIVERY

All documents will be sent to the return address on the outer envelope. If no address is found, the documents will be sent to the principal office. If the

applicant wishes for correspondence from the Office of the Secretary of State to be sent to someone other than those above, a request must be

submitted in writing affirming that request. All other communication and notification shall follow the process prescribed in Kentucky Revised Statute.

FILING FEE

The filing fee for this document is $40.00. Checks should be made payable to the "Kentucky State Treasurer."

MAILING ADDRESS

OFFICE LOCATION

Trey Grayson

Room 154, Capitol Building

Secretary of State

700 Capital Avenue

P. O. Box 718

Frankfort, KY 40601

Frankfort, KY 40602-0718

Hours of Operation: 8:00 AM-4:30 PM ET