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 Amended Certificate of Assumed Name (Domestic or Foreign Business Entity) AAN __________________________________________________________________________________________ Pursuant to the provisions of KRS 365, the undersigned applies to amend the certificate of assumed name and, for that purpose, submits the following statement: 1. The assumed name is____________________________________________________________________________. (The name must be identical to the name on record with the Secretary of State.) 2. The certificate of assumed name was filed with the Secretary of State on: __________________________________. 3 The current principal office address (if any) is: ____________________________________________ __________________________ ____________ _____________. Street Address or Post Office Box Numbers City State Zip 4. The principal office address is hereby changed to: ____________________________________________ __________________________ ____________ _____________. Street Address or Post Office Box Numbers City State Zip 5. 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) 6. The changes in the identity of the partners are as follows: ________________________________________________ ________________________________________________________________________________________________. I declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct. __________________________________ ____________________________________ _____________________ _______________ Signature of Applicant Printed Name Title Date (01/12) American LegalNet, Inc. www.FormsWorkFlow.com FILING INSTRUCTIONS AMENDED CERTIFICATE OF ASSUMED NAME NAME The certificate must state the assumed name under which business will be conducted or transacted. The assumed name must be a name that is distinguishable upon the records of the Secretary of State from any other name previously filed and on record with the Secretary of State. A separate certificate must be filed for each assumed name that is being adopted by the business. KRS 365.015(3) requires the certificate of assumed name for an individual (sole proprietorship) to be filed with the county clerk where the person is deemed a resident for the purposes of and under the provisions of KRS Chapter 355. An assumed name registration is effective for a term of five (5) years from the date it is filed with the Secretary of State and may be renewed for a successive term upon filing a renewal certificate. A renewal certificate must be filed with the Secretary of State within six (6) months prior to the expiration date. A renewal certificate filed with the Secretary of State renews the assumed name for a five-year term. The business entity should arrange its own reminder of the renewal deadline, since the Secretary of State is not required to send renewal certificates. Any certificate of assumed name in effect on July 15, 1998, shall continue in effect for five (5) years and may be renewed by filing a renewal certificate with the Secretary of State. 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 submitted. REAL NAME The real name is defined as follows: The real name of a Domestic General Partnership is the name that includes the real name of each general partner; The real name of a Domestic Registered Limited Liability Partnership is the name stated in its statement of registered limited liability partnership filed pursuant to KRS Chapter 362; The real name of a Domestic Limited Partnership is the name stated in its Certificate of Limited Partnership filed pursuant to KRS 362; The real name of a Domestic Business Trust is the name set forth in its Declaration of Trust; The real name of a Domestic Corporation is the name set forth in its Articles of Incorporation; The real name of a Domestic Limited Liability Company is the name set forth in its Articles of Organization; The real name of a Foreign General or Limited Partnership and of a Foreign Business Trust is the name recognized by the laws of the foreign state under which it is formed as being the real name or the fictitious name adopted for use in this state; The real name of a Foreign Limited Liability Partnership is the name stated in its statement of foreign qualification filed pursuant to KRS 362.1 The real name of a Foreign Corporation is the name set forth in its Articles of Incorporation or the fictitious name adopted for use in this state under KRS 271B.15-060; or The real name of a Foreign Limited Liability Company is the name set forth in its articles of organization or the fictitious name adopted for use in this state under KRS 275.410. EFFECTIVE DATE AND TIME/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 cannot 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. WHO MAY SIGN The document must be signed by: at least one partner authorized to do so by the partners of a Domestic or Foreign General Partnership; at least one partner authorized to do so by the partners of a Domestic or Foreign Registered Limited Liability Partnership; a general partner of a Domestic or Foreign Limited Partnership; the trustees of a Domestic or Foreign Business Trust; any person authorized to act for the Domestic or Foreign Corporation; or a member or manager authorized to act for the Domestic or Foreign Limited Liability Company. DOCUMENT DELIVERY A file stamped postcard will be sent to the principal office address. If the applicant wishes for the documen