Fill and Sign the Statement of Change of Registered Agent Kentucky Form

(05/17) C OMMONWEALTH OF KENTUCKY A LISON LUNDERGAN GRIMES , S ECRETARY OF STATE ____________________________________________________________________________________________ _____________________________ Division of Business Filings Business Filings PO Box 718 Frankfort, KY 40602 (502) 564-3490 __________________________________________________________________________________________ Pursuant to the provisions of KRS 14A and KRS 271B, 273, 274, 275, 362 or 386 the undersign ed hereby applies to change the registered agent and/or registered office address on behalf of ______________________________________________________________ and for that purpose s ubmits the following: (T he name must be identical to the name on record with the Secretary of State .) 2 . Registered agent currently on file: Registered agent is hereby changed to: ___________________________________________ Name: __________________________________ ___ I consent to serve as the registered agent on behalf of the business entity. X Signature:_________________________________ Registered office address currently on file: Registered office address is hereby changed to (must be a Kentucky street address): __ ___________________________________ ______ ___________________________________________ ___ __________________________________ ______ __________________________________________ ________________________________ ___________ __________________________________________ Fee: The fee for this filing is $10. I declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct . X ________________________________________________________________________________ ______________ Signature of Authorized Agent Printed Name Date Statement of Change of Registered Agent RAC and/or Registered Office Address (05/17) FILING INSTRUCTIONS STATEMENT OF CHANGE OF REGISTERED AGENT, AND/OR REGISTERED OFFICE NAME Use the exact name of the business entity as registered on file with th e Office of the Secretary of State. REGISTERED OFFICE AND REGISTERED AGENT The registered office of the business entity must be in Ken tucky and maintain street address or other specific location (Highway, Rural Route, Building etc.) A post office box is insufficient for the regi stered office address. The registered agent shall be an individual resident of this Commonwealth, a Kentucky corporation, a Kentuc ky nonprofit corporation, a Kentucky limited liability company , a foreign corporation, a foreign nonprofit corporation, a foreign li mited liability authorized to transact business in Kentucky. T he company seeking formation shall not act as its own registered agent. Th e registered agents address must be identical with the re gistered office. CONSENT OF REGISTERED AGENT The registered agent must give written consent to act as agent on b ehalf of the business entity. If the registered agent is a corporation an officer or the chairman of the board of directors must sign on b ehalf of the corporation. If the registered agent is a limited liability company and management of the company is vested in one or more ma nagers, a manager must sign on behalf of the limited liabili ty 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 capa city in which he or she signs. DOCUMENT DELIVERY A file stamped postcard will be sent to the principal offic e address. If the applicant wishes for the document to be s ent 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. WHO MAY SIGN The document must be signed by an officer, chairman of the boa rd, member, manager, partner or trustee. NUMBER OF COPIES When filing online, no copies are required. If filing vi a mail or in person, one exact copy of the document with t he filing fee must be submitted to the address below. To make a copy of the fi ling 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 changing the registered agent or registe red office address is $10.00. Checks should be made payab le 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 If you have any questions, please feel free to visit our website a t www.sos.ky.gov or call 502 -564-3490.