(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 362.1, the undersigned partnership submits the following statement:
1. Name of the partnership electing to be a limited liability partnership is:
________________________________________________________________________________________________.
2. 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.)
3. The mailing address of principal office of the limited liability partnership is:
_________________________________________________________________________________________________
Street Address or Post Office Box Numbers City State Zip Code
4. The mailing address/chief executive office of any partnership office in Kentucky (if any) is:
_________________________________________________________________________________________________
Street Address or Post Office Box Numbers City State Zip Code
5. The street address of the partnership’s initial registered office in Kentucky is:
_________________________________________________________________________________________________
Street Address (No Post Office Box Numbers) City State Zip Code
6. The name of the initial registered agent at that office is:
________________________________________________________________________________________________.
7. The above partnership elects to be a limited liability partnership.
8. The partnership previously filed a Statement of Authority with the Secretary of State on________________________.
Date
9. 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)
We declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct.
_______________________________ ___________________________ _____________________
Signature of Partner Printed Name Date
_______________________________ ___________________________ _____________________
Signature of Partner Printed Name Date
I, _____________________________________, consent to serve as the registered agent on behalf of the limited liability
partnership.
________________________________________________________________ ________________________________________ ________________
Signature of Registered Agent Printed Name Date
Statement of Qualification KNL
(Domestic Limited Liability Partnership)
(01/12)
FILING INSTRUCTIONS
STATEMENT OF QUALIFICATION
NAME
The name of the limited liability partnership shall end with “Registered Limited Liability Partnership,” “Limited Liability Partnership,” “R.L.L.P.,” “L.L.P,”
“RLLP,” or “LLP.”
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 statement, the partnership must deliver with the statement of qualification, the registered agent’s consent to the
appointment. The registered agent must give written consent to act as agent on behalf of the limited liability partnership. 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.
WHO MAY SIGN
The document must be signed by at least two partners.
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.
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
Submit the original statement of limited liability partnership and one (1) exact or conformed copy. One file-stamped copy must then be filed with the
county clerk of the county in which the partnership’s registered office is situated.
FILING FEE
The filing fee is $40.00. 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
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 limited partnership must file an annual report with the Office of the Secretary
of State between January 1 and June 30 of the year following the calendar year in which the partnership was formed. Subsequent annual reports must
be filed with the Office of 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 Office of the Secretary of State whenever a change
has occurred involving any of the above categories. You may file your statement of change or annual report online at www.sos.ky.gov.