(07/20)
COMMONWEALTH OF KENTUCKY
MICHAEL G. ADAMS, SECRETARY OF STATE
___________________________________________________________________________________________________________________________
Division of Business Filings
P.O. Box 718,
Frankfort, KY 40602
(502) 564-3490
www.sos.ky.gov
____________________________________________________________________________________________
NOTICE: This registration only reserves a name for future use. It does not authorize the entity to do business in
Kentucky. To do that, you must submit an Application for Certificate of Authority.
Pursuant to the provisions of KRS 14A and KRS Chapter 271B, 273, 274, 275, 362 or 386, the undersigned applies for
registration or renewal and, for that purpose, submits the following statements:
1. The entity is a: profit corporation (KRS 271B). nonprofit corporation (KRS 273).
professional service corporation (KRS 274). business trust (KRS 386).
limited liability company (KRS 275). limited partnership (KRS 362).
professional limited liability company (KRS 275). Statutory trust
limited cooperative association non-profit limited liability company
cooperative association limited liability partnership (LLP)
2. The activity request is:
Registration
Renewal
3. The name of the entity is ____________________________________________________________________________.
4. The state or country of organization is __________________________________________________________________.
5. The date of organization is ___________________________________________________________________________.
6. The mailing address of the entity is
Street Address or Post Office Box Numbers City State Zip Code
7. The nature of the business of the entity is ________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
8. This application will be effective upon filing.
I/We declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct.
___________________________________ _______________________ __________________ ______________
Signature of Authorized Agent Printed Name Title Date
Registration or Renewal of Entity Name REG
(Foreign Business Entity)
(1/20)
FILING INSTRUCTIONS
REGISTRATION OR RENEWAL OF ENTITY NAME
NOTICE: This registration only reserves a name for future use. It does not authorize the entity to do business in
Kentucky. To do that, you must submit an Application for Certificate of Authority.
TYPE OF FORMATION
The entity must indicate if it is a corporation (KRS 271B), a nonprofit corporation (KRS 273), a professional service corporation
(KRS 274), a business trust (KRS 386), a limited liability company (KRS 275) or a limited partnership (KRS 362) by checking the
appropriate box.
REGISTRATION OR RENEWAL
If the entity is applying for renewal of registration of company name, check appropriate block. Please note: A registered name is effective
when filed with the Secretary of State and expires on December 31
st
of the same year. A registered name may be renewed for successive
years between October 1
st
and December 31
st
of the preceding year. When the renewal is effective, it renews the entity name registration
for the following calendar year.
DATE OF FORMATION
The date of formation is the date the entity was organized in the state or country of its organization.
PRINCIPAL OFFICE ADDRESS
The principal office is the office (in or out of this state) so designated in writing with the Office of the Secretary of State where the principal
designated office of the business entity is located. This address is where all correspondence from the Office of the Secretary of State (See
Document Delivery) will be mailed.
NATURE OF BUSINESS
The entity must give a brief description of the nature of the business in which it is engaged.
EFFECTIVE DATE AND TIME
The document will be effective on the date and time of filing.
WHO MAY SIGN
The document may be signed by the chairman of the board, president, officer, manager, member general partner, trustee or authorized
representative.
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.
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.
FILING FEE
The filing fee for this document is $36.00. Checks should be made payable to the "Kentucky State Treasurer."
MAILING ADDRESS OFFICE LOCATION
Michael Adams Room 154, Capitol Building
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 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.