(01/12)
COMMONWEALTH OF KENTUCKY
ALISON LUNDERGAN GRIMES, SECRETARY OF STATE
____________________________________________________________________________________________________________________________
Division of Business Filings
Business Filings
PO Box 718
Frankfort, KY 40602
(502) 564-3490
www.sos.ky.gov
____________________________________________________________________________________________
Pursuant to the provisions of KRS 14A and KRS 271B, 273, 274, 275, 362 or 386, the undersigned applies to reserve or
renew a name and, for that purpose, submits the following statement:
1. The activity request is:
Reservation
Renewal
2. The proposed name to be reserved or renewed with the Secretary of State for a period of 120 days is
_________________________________________________________________________________________________.
3. The name is reserved as:
A corporate name (KRS 271B, KRS 273 or KRS 274)
A limited liability company name (KRS 275)
A limited partnership name (KRS 362)
A limited liability partnership name (KRS 362)
A business trust name (KRS 386)
4. The name and mailing address of the applicant is:
______________________________________ ________________________________ _____________ ______________.
Street Address or Post Office Box Numbers City State Zip
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 Applicant Printed Name Title Date
Reservation or Renewal of Reserved Name RES
(Domestic or Foreign Entity)
(01/12)
FILING INSTRUCTIONS
RESERVATION OR RENEWAL OF RESERVED NAME
NAME
The name must be available according to the records with the Office of the Secretary of State. In order to confirm if a name is available,
visit the organizational search tool at www.sos.ky.gov. A name may be renewed thirty days prior to the expiration.
WHO MAY SIGN
The document must be signed by the applicant.
APPLICANT ADDRESS
The applicant address is the office (in or out of this state) so designated in writing with the Office of the Secretary of State where all
correspondence from the Office of the Secretary of State will be mailed.
DOCUMENT DELIVERY
A file stamped postcard will be sent to the applicant address. If the applicant wishes for the document to be sent to an alternate address
other than the applicant address, 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.
DELAYED EFFECTIVE DATE AND TIME
The document will be effective on the date and time of filing, unless a delayed effective date and/or time is specified. The effective date or
the delayed effective date cannot be prior to the date the application is filed. A delayed effective date may not be later than the 90
th
day
after the date of filing.
NUMBER OF COPIES
If filing via mail or in person, one exact or conformed copy of the documents 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 this document is $15.00. Checks should be made payable to the "Kentucky State Treasurer."
MAILING ADDRESS OFFICE LOCATION
Alison Lundergan Grimes Room 154, Capitol Building
Office of the Secretary of State 700 Capital Avenue
PO Box 718 Frankfort, KY 40601
Frankfort, KY 40602-0718 Hours of Operation: 8:00 AM-4:30 PM ET
CONTACT INFORMATION AND NAME AVAILABILITY
If you have any questions, need additional forms or wish to search for name availability, please feel free to visit our website at
www.sos.ky.gov or call (502) 564-3490.