(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 KRS 14A and 362, the undersigned applies to qualify and for that purpose submits the following statements:
1. Name of the partnership: __________________________________________________________________________________.
2. Complete address of its chief executive office (address must be a street address):
_______________________________________________________ ____________________________________ ___________________________ ______________
Street City State Zip Code
3. Complete address of the partnership’s office in the state of Kentucky, if one exists:
______________________________________________________ ______________________________________ __________________________ ______________
Street or PO Box Number City State Zip Code
4. Names and mailing addresses of all partners, or the name and mailing address of an agent appointed to maintain a list of names
and mailing addresses of all partners (please designate if partner or agent):
__________________ _______________________________________________________ ___________________________ ________________ ________________
Name Street or PO Box Number City State Zip Code
__________________ _______________________________________________________ ___________________________ __________________ _____________
Name Street or PO Box Number City State Zip Code
__________________ _______________________________________________________ ___________________________ __________________ _____________
Name Street or PO Box Number City State Zip Code
5. The partner(s) authorized to execute an instrument transferring real property held in the name of the partnership:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
6. The partnership filed a Statement of Qualification (foreign or domestic) on ___________________________________________.
7. The authority or limitation on authority of some or all partners to enter into other transactions on behalf of the partnership 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)
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 Title Date
______________________________________ __________________________ __________________ __________
Signature of Partner Printed Name Title Date
Statement of Partnership Authority KNG