C
K
OMMONWEALTH OF
ENTUCKY
A
L
G
, S
S
LISON
UNDERGAN
RIMES
ECRETARY OF
TATE
_________________________________________________________________________________________________________________________
Division of Business Filings
Statement of Resignation of Registered Agent
SRA
Business Filings
(Domestic or Foreign Business Entity)
PO Box 718
Frankfort, KY 40602
(502) 564-3490
__________________________________________________________________________________________
Pursuant to the provisions of KRS Chapter 14A and 271B, 273, 274, 275, 362 or 386, the undersigned applies for
resignation of registered agent and, for that purpose, submits the following statements:
1. I, ____________________________________________________________________________________, do hereby
resign as registered agent; and/or
discontinue the registered office address
2. The business entity which I am resigning from is_______________________________________________________,
(The name must be identical to the name on record with the Secretary of State.)
3. The business is:
a corporation (KRS 271B, KRS 273 or KRS 274);
a limited liability company (KRS 275);
a limited partnership (KRS 362);
a limited liability partnership (KRS 362); or
a business trust (KRS 386)
4. The business entity was organized and existing in the state or country of __________________________________.
5. The mailing address of the resigning agent:
_________________________________________________________________________________________________
Street Address or Post Office Box Numbers
City
State
Zip
st
6. The agency appointment shall be terminated and the registered office discontinued, if so provided, on the 31
day after
the date on which the statement is filed.
I declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct.
__________________________________________________________________________________________________
Signature of Registered Agent
Printed Name
Date
(01/12)
1
2
