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COMMONWEALTH OF KENTUCKY
MICHAEL G. ADAMS, SECRETARY OF STATE
_________________________________________________________________________________________________________________________
Division of Business Filings
P.O. Box 718
Frankfort, KY 40602
(502) 564-3490
__________________________________________________________________________________________
Pursuant to the provisions of KRS 14A and KRS 271B, 273, 274, 275, 362 or 386 the undersigned hereby applies to
change the registered agent and/or registered office address on behalf of
______________________________________________________________ and for that purpose submits the following:
(The name must be identical to the name on record with the Secretary of State.)
2. Registered agent currently on file: Registered agent is hereby changed to:
___________________________________________ Name: _____________________________________
I consent to serve as the registered agent on behalf of
the business entity.
X Signature: ________________________________
Registered office address currently on file: Registered office address is hereby changed to:
(must be a Kentucky street address):
___________________________________________ ___________________________________________
___________________________________________ __________________________________________
___________________________________________ __________________________________________
Fee: The fee for this filing is $10.
I declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct:
X _____________________________________________________________________________________________
Signature of Authorized Agent Printed Name Date
Statement of Change of Registered Agent RAC
and/or Registered Office Address
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FILING INSTRUCTIONS
STATEMENT OF CHANGE OF REGISTERED AGENT, AND/OR REGISTERED OFFICE
NAME
Use the exact name of the business entity as registered on file with the Office of the Secretary of State.
REGISTERED OFFICE AND REGISTERED AGENT
The registered office of the business entity must be in Kentucky and maintain street address or other specific location (Highway, Rural
Route, Building etc.) A post office box is insufficient for the registered office address. The registered agent shall be an individual
resident of this Commonwealth, a Kentucky corporation, a Kentucky nonprofit corporation, a Kentucky limited liability company, a
foreign corporation, a foreign nonprofit corporation, a foreign limited liability authorized to transact business in Kentucky. The company
seeking formation shall not act as its own registered agent. The registered agents address must be identical with the registered office.
CONSENT OF REGISTERED AGENT
The registered agent must give written consent to act as agent on behalf of the business entity. If the registered agent is a corporation
an officer or the chairman of the board of directors must sign on behalf of the corporation. If the registered agent is a limited liability
company and management of the company is vested in one or more managers, a manager must sign on behalf of the limited liability
company. If management of the company is vested in its members, a member must sign. The person signing on behalf of the
business entity acting as agent must designate the title or capacity in which he or she signs.
DOCUMENT DELIVERY
A file stamped postcard will be sent to the principal office address. If the applicant wishes for the document to be sent to an alternate
address other than the principal office, a request must be submitted in writing affirming that request. Alternate address requests must
be submitted with each document filed with the Office of the Secretary of State.
WHO MAY SIGN
The document must be signed by an officer, chairman of the board, member, manager, partner or trustee.
NUMBER OF COPIES
When filing online, no copies are required. If filing via mail or in person, one exact copy of the document with the filing fee must be
submitted to the address below. To make a copy of the filing for delivery to the local county clerk’s office, visit www.sos.ky.gov and
print a copy from the organization search tool.
FILING FEE
The filing fee for changing the registered agent or registered office address is $10.00. Checks should be made payable to the
"Kentucky State Treasurer."
MAILING ADDRESS OFFICE LOCATION
Michael Adams Room 154, Capitol Building
Office of the Secretary of State 700 Capital Avenue
P.O. Box 718 Frankfort, KY 40601
Frankfort, KY 40602-0718 Hours of Operation: 8:00 AM-4:30 PM ET
CONTACT INFORMATION
If you have any questions, please feel free to visit our website at www.sos.ky.gov or call 502-564-3490.