Fill and Sign the Articles of Incorporation Professional Service Form

(0517 ) C O M M O N W E A L T H OF K E N T U C K Y A LISON LUNDERGAN GRIMES , S ECRETARY 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 KRS 275, the undersigned applies to qualify and for that purpose submits the following statements: Article I: The name of the professional limited liability company is _________________________________________________________________________________ __________________. Article II: The street address of the professional limited liability company ’s initial registered office in Kentucky is ___________________________________________________ ___________________ ____________ ________________ Street Address Only (No Post Office Box Numbers) City State Zip Code and the name of the initial registered agent at that office is ____________________________ ________________________. Article III: The mailing address of the professional limited liability company’s initial principal office is ___________________________________________________ ___________________ ___________ _ _____________ __. Street Address or Post Office Box Number City State Zip Code Article IV: The professional limited liability company is to be managed by (m ust check one): _____ A. a manager(s). _____ B. its member(s). Article V: The profession to be practiced through the professional limited liability com pany: ________________________________________________________________________________ ___________________. Article VI: This application will be effective upon filing, unless a delayed effective date and/or time is provided. The eff ective date or the delayed effective date cannot be prior to the date the application is filed. The date and /or time is_____________. Please indicate the county in which your business operates: County: ___________________________________________. To complete the following, please shade the box completely. Please indicate the size of your business:  Small (Fewer than 50 employees)  Large (50 or more employees) Please indicate whether any of the following make up more than fifty percent (50%) of your business ownership:  Women- Owned  Veteran Owned  Minority Owned Please indicate which of the following best describes your business:  Agriculture  Wholesale Trade  Public Administration  Other  Mining  Retail Trade  Services  Manufacturing  Construction  Finance, Insurance, Real Estate  Transportation, Communications, Electric, Gas, Sanitary Services  I/We declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true an d correct. _____________________________________________ ________________________________ _____________________ Signature of Organizer Printed Name Date _____________________________________________ ________________________________ _____________________ Signature of Organizer Printed Name Date _____________________________________________ ________________________________ _____________________ Signature of Organizer Printed Name Date I, ________________________________________________ ______, consent to serve as the registered agent on behalf of the limited liability company. Print Name of Registered Agent _________________________ _______________________________ ________________________________________ __________________________ Signature of Registered Agent Printed Name Date Articles of Organization PLC Professional Limited Liability Company (0517 ) FILING INSTRUCTIONS ARTICLES OF ORGANIZATION NAME The professional limited liability company name must contain the words “professional limi ted liability company,” “professional limited company,” “PLC,” or “PLLC.” The limited liability company name must contain the words “limited liability company” or “limited com pany” or the abbreviation “LLC” or “LC.” If you wish to abbreviate “limited company,” you must use the abbreviation “LTD CO.” A professional limited liability company name must be distinguishable from any nam e on record with the Office of the Secretary of State. 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 even t 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 certificate, the corporation must deliver wit h 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 corporation. 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 managem ent 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 th e title or capacity in which he or she signs. ADDITIONAL ARTICLES OF ORGANIZATION OR NEED TO MODIFY THE EXI STING FORM If this form does not comply with the articles of organization that you wis h to file (ie: additional articles, signatures, etc.), please disregard this form and send a drafted executed copy of the articles of organization according to KRS 275 to the address bel ow. PRINCIPAL OFFICE ADDRESS The principal office is the office (in or out of this state) so designated in writing w ith the Office of the Secretary of State (SOS) where the principal designated office of the business entity is located. This address is where all correspondence from t he SOS (See Document Delivery) will be mailed. DELAYED 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 ca nnot be prior to the date the application is filed. A delayed effective date may not be later than the 90th day after the date of filing. 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. Al ternate address requests must be submitted with each document filed with t he Office of the Secretary of State. MANAGEMENT “Manager (s)” means that the professional limited liability company has set forth in its articles of organization that it is to be managed by m anagers. “Member(s)” means the person(s) who have been admitted to membership in a professional l imited liability company. PROFESSIONAL SERVICES Professional services mean the personal services rendered by physicians, osteopaths, optometrists, podiatrists, chiropractors, dentists, nurses, pharmacists, psychologists, occupational therapists, veterinarians, engineers, architects, lands cape architects, certified public accountants, public accountants, physical therapis t and attorneys. REGULATING BOARD The regulating board is the governmental agency that is charged by law with the lic ensing and regulation of the practice of the profession that the professional limited liability company is organized to provide. WHO MAY SIGN The document must be signed by the organizer. NUMBER OF COPIES When filing online with the One Stop Business Portal system, no copies are required. If f iling via mail or in person, one exact or conformed copy of the document with the filing fee must be submitted to the address below. To make a copy o f 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. FILING FEE The filing fee for Articles of Organization is $40.00. Your check should be made pay able 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 liability company must file an annual report with the SOS between January 1 and June 30 of the year following the calendar year in which the corporation was formed. Su bsequent annual reports must be filed with the SOS 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 SOS whenever a change has occurred involving any of the above categories.