COMMONWEALTH OF KENTUCKY TREY GRAYSON, SECRETARY OF STATE ____________________________________________________________________________________________________________________________ Division of Corporations Business Filings PO Box 718 Frankfort, KY 40602 (502) 564-3490 www.sos.ky.gov Amended Certificate of Authority FCA (Foreign Corporation) __________________________________________________________________________________________ Pursuant to the provisions of KRS Chapter 271B, 273 or 274, the undersigned hereby applies for an amended certificate of authority on behalf of the corporation named below and, for that purpose, submits the following statements: 1. The corporation is: a profit corporation (KRS 271B) a nonprofit corporation (KRS 273) a professional service corporation (KRS 274) 2. The name of the company is: ___________________________________________________________________________________________________. (The name must be identical to the name on record with the Secretary of State.) 3. It is a corporation organized and existing under the laws of the state or country of _______________________________. 4. The corporation received authority to transact business in Kentucky on ________________________________________. 5. The corporation’s name in the state or country of incorporation has been changed to ___________________________________________________________________________________________________. 6. The name of the corporation to be used in Kentucky is ___________________________________________________________________________________________________. (If real name is unavailable, use the fictitious name adopted for use in Kentucky.) 7. The corporation’s period of duration has been changed to ___________________________________________________. 8. The corporation's state or country of incorporation has been changed to________________________________________. 9. A certificate of existence duly authenticated by the Secretary of State accompanies this application. 10. 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 declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct. ____________________________________________________________________________________________________ Signature of Officer or Chairman of the Board (08/10) Printed Name & Title Date American LegalNet, Inc. www.FormsWorkFlow.com FILING INSTRUCTIONS APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY TYPE OF CORPORATION The corporation must indicate if it is a business corporation (KRS 271B), a nonprofit corporation (KRS 273), or a professional service corporation (KRS 274) by checking the appropriate box. CERTIFICATE OF EXISTENCE A certificate of existence or document of similar import (for example, certificate of “good standing”) must accompany this application. Please contact the Office of the Secretary of State of the domiciled state for a certificate of existence. 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 th effective date cannot be prior to the date the application is filed. A delayed effective date may not be later than the 90 day after the date of filing. WHO MAY SIGN The document must be signed by an officer or chairman of the board. NUMBER OF COPIES Profit and professional services corporations are only required to submit one original copy. Nonprofit corporations are required to submit the original signed certificate of authority and two exact or conformed 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 All documents will be sent to the return address on the outer envelope. If no address is found, the documents will be sent to the principal office. If the applicant wishes for correspondence from the Office of the Secretary of State to be sent to someone other than those above, a request must be submitted in writing affirming that request. All other communication and notification shall follow the process prescribed in Kentucky Revised Statute. FILING FEE The filing fee for a profit corporation or a professional service corporation is $40.00. The filing fee for a nonprofit corporation is $8.00. Checks should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS Trey Grayson Secretary of State PO Box 718 Frankfort, KY 40602-0718 OFFICE LOCATION Room 154, Capitol Building 700 Capital Avenue Frankfort, KY 40601 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. (08/10) American LegalNet, Inc. www.FormsWorkFlow.com