Form Wbe - Withdrawal Of Filing Before Effectiveness (Domestic Or Foreign Entity) - 2012
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1
2C
K
OMMONWEALTH OF
ENTUCKY
A
L
G
, S
S
LISON
UNDERGAN
RIMES
ECRETARY OF
TATE
_________________________________________________________________________________________________________________________
Division of Business Filings
Withdrawal of Filing Before Effectiveness
WBE
Business Filings
(Domestic or Foreign Entity)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
_________________________________________________________________________________________________
Pursuant to the provisions of KRS 14A, the undersigned applies for a certificate of withdrawal on behalf of the business
entity named below and, for that purpose, submits the following statements:
1. The name of the business entity is __________________________________________________________________.
(The name must be identical to the name on record with the Secretary of State.)
2. The name of the document to be withdrawn___________________________________________________________.
3. The date the document was filed in Kentucky__________________________________________________________.
4. The document has been withdrawn in accordance with the agreement of the parties.
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 Authorized Agent
Printed Name
Date
_________________________________________________________________________________________________
Signature of Authorized Agent
Printed Name
Date
(01/12)
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