(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 applies to qualify and for that purpose submits the following
statement:
1. The name of the foreign 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 the partnership’s principal office address is:
_____________________________________________ _________________________ ____________ ___________.
Street Address or Post Office Box Numbers City State Zip
4. The mailing address of the principal office address of any partnership office in Kentucky (if applicable):
_____________________________________________ _________________________ ____________ ___________.
Street Address or Post Office Box Numbers City State Zip
5. The street address of the partnership’s initial registered office in Kentucky is
_____________________________________________ _________________________ ____________ ___________.
Street Address (No Post Office Box Numbers) City State Zip
6. The name of the initial registered agent at that office is _____________________________________________________________.
7. The state or country of jurisdiction of the organization is____________________________________________________________.
8. 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/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 Foreign Qualification FNL
(Foreign Limited Liability Partnership)
(01/12)
FILING INSTRUCTIONS
STATEMENT OF FOREIGN QUALIFICATION
PARTNERSHIP NAME
The name of the limited liability partnership must end with the words “R.L.L.P.,” “L.L.P.,” “RLLP,” “LLP,” “Registered Limited Liability Partnership” or
“Limited Liability Partnership.”
STATE OR JURISDICTION
List the state or country of the 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.
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.
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 $90.00. 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.