Fillable Kentucky-Certificate-of-Authority Kentucky Secretary of State

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Kentucky-Certificate-of-Authority Kentucky Secretary of State

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(09/15)
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 and 386 the undersigned hereby applies for authority to transact business in Kentucky
on behalf of the entity named below 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). professional limited liability company (KRS 275).
limited partnership (KRS 362).
2. The name of the entity is_________________________________________________________________________________________________________.
(The name must be identical to the name on record with the Secretary of State.)
3. The name of the entity to be used in Kentucky is (if applicable):__________________________________________________________________________.
(Only provide if "real name" is unavailable for use; otherwise, leave blank.)
4. The state or country under whose law the entity is organized is___________________________________________________________________________.
5. The date of organization is _______________________________________and the period of duration is _________________________________________.
(If left blank, the period of duration
is considered perpetual.)
6. The mailing address of the entity’s principal office is
_______________________________________________________________ _________________________ _______________ _____________________.
Street Address City State Zip Code
7. The street address of the entity’s registered office in Kentucky is
_______________________________________________________________ _________________________ _______________ _____________________.
Street Address (No P.O. Box Numbers) City State Zip Code
and the name of the registered agent at that office is _____________________________________________________________________________________.
8. The names and business addresses of the entity’s representatives (secretary, officers and directors, managers, trustees or general partners):
_______________________________ ________________________________ ________________________ _______________ ______________________
Name Street or P.O. Box City State Zip Code
________________________________ _______________________________ ________________________ ________________ ____________________
Name Street or P.O. Box City State Zip Code
________________________________ _______________________________ ________________________ ________________ ____________________
Name Street or P.O. Box City State Zip Code
9. If a professional service corporation, all the individual shareholders, not less than one half (1/2) of the directors, and all of the officers other than the secretary and treasurer are licensed in one or
more states or territories of the United States or District of Columbia to render a professional service described in the statement of purposes of the corporation.
10. I certify that, as of the date of filing this application, the above-named entity validly exists under the laws of the jurisdiction of its formation.
11. If a limited partnership, it elects to be a limited liability limited partnership. Check the box if applicable:
12. If a limited liability company, check box if manager-managed:
13. 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)
_____________________________________________ _______________________________ _________________________
Signature of Authorized Representative Printed Name & Title Date
I, _________________________________________________________, consent to serve as the registered agent on behalf of the business entity.
Type/Print Name of Registered Agent
______________________________________ _________________________ _________________________ ____________
Signature of Registered Agent Printed Name Title Date
Certificate of Authority FBE
(Foreign Business Entity)
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(09/15)
FILING INSTRUCTIONS
APPLICATION FOR CERTIFICATE OF AUTHORITY FOR A FOREIGN BUSINESS ENTITY
TYPE OF FORMATION
The corporation 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.
NAME
The business entity name must be exactly as written in the home state and comply with the ending requirements of KRS 14A.3-010.
DATE OF ORGANIZATION AND DURATION
The date of organization is the date the business entity filed with the secretary of state or other official having custody of corporate records.
The period of duration of the business entity is that period which is stated in the organization filing. (May be perpetual or a total number of years.)
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.
REGISTERED OFFICE AND REGISTERED AGENT
The registered office of the business entity must be in Kentucky and maintain a street address (a PO Box is insufficient for the registered office address). In
order to transact business in Kentucky, the registered agent shall be an individual resident of Kentucky, a Kentucky domestic corporation, a Kentucky domestic
non-corporation, a Kentucky domestic limited liability company, a foreign corporation, a foreign non-corporation or a foreign limited liability company authorized
to transact business in Kentucky. The registered agent is the individual or business designated to receive service of process in the event the business is party to
a legal action. The company seeking formation shall not act as its own registered agent.
CONSENT OF REGISTERED AGENT
Unless the registered agent signs the form, the business entity must deliver with the certificate of authority, the registered agent’s consent to the appointment.
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.
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. A delayed effective date may not be later
than the 90
th
day after the date of filing.
WHO MAY SIGN
The document must be signed by an officer, chairman of the board, member, manager, trustee or a partner.
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 is $90.00 for all business entity types. Checks should be made payable to the "Kentucky State Treasurer."
MAILING ADDRESS OFFICE LOCATION
Alison Lundergan Grimes 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.
FUTURE DOCUMENTATION REQUIREMENTS AND DEADLINES
The business entity must file an annual report with the Secretary of State between January 1 and June 30 of the year following the calendar year in which the
corporation was formed. Subsequent annual reports must be filed with the Secretary of State between January 1 and June 30 of the following calendar years.
A statement of change of the registered agent and/or registered office address or principal office address must be filed with the Secretary of State whenever a
change has occurred involving any of the above categories. Downloadable forms may be found on our website.
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Kentucky-Certificate-of-Authority Kentucky Secretary of State

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Completed 3 July 2020

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