Form Ssc-104 - Application For Registration Or Renewal Of Corporate Name - 1998
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1COMMONWEALTH OF KENTUCKY
TREY GRAYSON
SECRETARY OF STATE
APPLICATION FOR REGISTRATION OR RENEWAL OF CORPORATE NAME
Pursuant to the provisions of KRS Chapter 271B or 273, the undersigned hereby applies for registration or
renewal of corporate name on behalf of the corporation named below and for that purpose submits the
following statements:
1.
Registration
Renewal
(CHECK ONE)
2. The name of the corporation is
_____________________________________________________________________________.
3. The state or country of incorporation is
_____________________________________________________________________________.
4. The date of incorporation is
_____________________________________________________________________________.
5. The nature of the business of the corporation is
______________________________________________________________________________
(Brief Description)
______________________________________________________________________________.
6. A certificate of existence duly authenticated by the Secretary of State accompanies this application.
_________________________________________
Signature
_________________________________________
Type or Print Name & Title
_________________________________________
Street Address
_________________________________________
City
State
Zip Code
Date: ______________________________, 20_______
SSC-104 (2/98)
(See attached sheet for instructions)
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