Filing Fee: Section 1: $10.00 Section 2: $10.00 Sections 1 and 2: $20.00 COMMONWEALTH OF KENTUCKY ALISON LUNDERGAN GRIMES, SECRETARY OF STATE _________________________________________________________________________________________________________________________ Division of Business Filings Business Filings PO Box 718 Frankfort, KY 40602 (502) 564-3490 Statement of Change RAC Principal Office Address, Registered Agent POC and/or Registered Office Address __________________________________________________________________________________________ Pursuant to the provisions of KRS 14A and KRS 271B, 273, 274, 275, 362 or 386 the undersigned hereby applies to change one or all of the following: the principal office address, the registered agent and/or registered office address on behalf of ______________________________________________________________ and for that purpose submits the following: (The name must be identical to the name on record with the Secretary of State.) 1. Principal office address currently on file: __________________________________________ __________________________________________ __________________________________________ Principal office is hereby changed to: __________________________________________ __________________________________________ __________________________________________ 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 fees for changing 1 or all of the following: Section 1 is $10. Section 2 is $10. Section 1 and 2 is $20. 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 (01/12) American LegalNet, Inc. www.FormsWorkFlow.com FILING INSTRUCTIONS STATEMENT OF CHANGE OF PRINCIPAL OFFICE ADDRESS, REGISTERED AGENT, AND/OR REGISTERED OFFICE NAME Use the exact name of the business entity as registered on file with the Office of 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 mailed. REGISTERED OFFICE AND REGISTERED AGENT The registered office of the business entity must be in Kentucky and maintain street address or other specific location (Highway, Rural Route, Building etc.) A post office box is insufficient for the registered office address. The registered agent shall be an individual resident of this Commonwealth, a Kentucky corporation, a Kentucky nonprofit corporation, a Kentucky limited liability company, a foreign corporation, a foreign nonprofit corporation, a foreign limited liability authorized to transact business in Kentucky. The company seeking formation shall not act as its own registered agent. The registered agents address must be identical with the registered office. CONSENT OF REGISTERED AGENT The registered agent must give written consent to act as agent on behalf of the business entity. 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 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 capacity in which he or she signs. 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. 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 board, member, manager, partner or trustee. NUMBER OF COPIES When filing online, no copies are required. If filing via mail or in person, one exact copy of the document 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. FILING FEE The filing fee for changing a principal office is $10.00. The filing fee for changing the registered agent or registered office address is $10.00. The fee for changing the principal office address and either the registered agent or the registered agent address is $20.00. Checks should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS Alison Lundergan Grimes Office of the Secretary of State P. O. 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 If you have any questions, please feel free to visit our website at www.sos.ky.gov or call 502-564-3490. (01/12) American LegalNet, Inc. www.FormsWorkFlow.com