Form Fca - Amended Certificate Of Authority (Foreign Business Entity) - 2012
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1C
K
OMMONWEALTH OF
ENTUCKY
A
L
G
, S
S
LISON
UNDERGAN
RIMES
ECRETARY OF
TATE
____________________________________________________________________________________________________________________________
Division of
Business Filings
Amended Certificate of Authority
FCA
Business Filings
(Foreign Business Entity)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
__________________________________________________________________________________________
Pursuant to the provisions of KRS Chapter KRS 14A and 271B, 273, 274, 275, 362 or 386 the undersigned hereby applies
for an amended certificate of authority on behalf of the entity named below and, for that purpose, submits the following
statements:
1. The business entity is:
profit corporation (KRS 271B).
nonprofit corporation (KRS 273).
professional service corporation (KRS 274).
business trust (KRS 386).
limited liability company (KRS 275).
limited partnership (KRS 362).
professional limited liability company (KRS 275).
2. The name of the company is:_________________________________________________________________________.
(The name must be identical to the name on record with the Secretary of State.)
3. It is an entity organized and existing under the laws of the state or country of _______________________________.
4. The entity received authority to transact business in Kentucky on ________________________________________.
5. The entity has changed its
(check all that apply)
Domicile name to ________________________________________________________________________
Name to be used in Kentucky to_____________________________________________________________
Jurisdiction of organization to_______________________________________________________________
Period of duration________________________________________________________________________
Form of organization______________________________________________________________________
6. 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 the state of Kentucky that the foregoing is true and correct.
____________________________________________________________________________________________________
Signature of Authorized Representative
Printed Name
Title
Date
(01/12)
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