Form Nai - Articles Of Incorporation - Non-Profit Corporation - 2012 With Instructions

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COMMONWE ALTH OF KENTUCKY
ALISON LUNDERGAN GRIMES, SECRETARY OF STATE
__________________________________________________________________________________________________________________________
Division of Business Filings
Articles of Incorporation
NAI
Business Filings
Non-profit Corporation
PO Box 718
Frankfort, KY 40602
Please note: This form does not comply with 501 (C) status. You should contact the Internal Revenue
(502) 564-3490
Service prior to filing the Articles of Incorporation.
Pursuant to KRS 14A and KRS 273, the undersigned applies to qualify and for that purpose submits the following statements:
Article I: The name of the corporation is_________________________________________________________________________________.
Article II: The purpose for which the corporation is organized_________________________________________________________________.
Article III: The name of the registered agent is ____________________________________________________________________________.
and the street address of the corporation’s initial registered office in Kentucky is
_________________________________________________ ______________________ _____________________ __________________.
Street Address (No Post Office Box Numbers)
City
State
Zip Code
Article IV: The mailing address of the corporation’s principal office is
_________________________________________________ ______________________ _____________________ __________________.
Street or PO Box Number
City
State
Zip Code
Article V: The number of directors (minimum of three (3) required) constituting the initial board of directors is __________________________.
The names and mailing addresses of the persons who are to serve as the initial board of directors are as follows:
_____________________ __________________________________________ _____________________ ______________ ___________
Name
Street or PO Box Number
City
State
Zip Code
________________________ _______________________________________________ ________________________ ________________ ____________
Name
Street or PO Box Number
City
State
Zip Code
________________________ _______________________________________________ ________________________ ________________ ____________
Name
Street or PO Box Number
City
State
Zip Code
Article VI: The name and mailing address of the incorporator is
________________________ _______________________________________________ ________________________ ________________ ____________
Name
Street Address or Post Office Box Number
City
State
Zip Code
________________________ _______________________________________________ ________________________ ________________ ____________
Name
Street Address or Post Office Box Number
City
State
Zip Code
________________________ _______________________________________________ ________________________ ________________ ____________
Name
Street Address or Post Office Box Number
City
State
Zip Code
Article VII: 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/We declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct.
_________________________________________________ ___________________________________ ___________________________
Signature of Incorporator
Print Name & Title
Date
I, ______________________________________________________, consent to serve as the registered agent on behalf of the corporation.
Print Name of Registered Agent
________________________________________________________ ________________________________________ _____________________________
Signature of Registered Agent
Print Name &Title
Date
(01/12)

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