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 Transfer of Reserved Name (Domestic and Foreign Entity) NOT __________________________________________________________________________________________ Pursuant to the provisions of KRS 14A and KRS Chapter 271B, 273, 274, 275, 362 or 386 the undersigned applies to transfer a reserved name and, for that purpose, submits the following statements: 1. The reserved name is_____________________________________________________________________________. (Name must be identical to the name on record with the Secretary of State.) 2. The name was reserved by ________________________________________________________________________. (Applicant's name) 3. The name as reserved is hereby transferred to _________________________________________________________. (Transferee's name) 4. The mailing address of the transferee is: _________________________________________________________________________________________________ Street Address or PO Box Numbers City State Zip Code 5. The date of filing of the original application to reserve the name was ________________________________________. 6. 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 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 TRANSFER OF RESERVED NAME NAME RESERVED AND APPLICANT'S NAME Please state the exact name as reserved with the Secretary of State. The applicant's name is the individual or the business entity that reserved the name for the applicants exclusive use for the remainder of the 120 day period. NOTE: The notice of transfer of reserved name will not renew the reservation. The reserved name, as transferred, will expire 120 days from the date the name was reserved with the Secretary of State. WHO MAY SIGN The individual applicant must sign the notice of transfer of reserved name. If the applicant is a business entity the person executing the notice on behalf of the business entity must state his or her title or the capacity in which he or she signs. 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. 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. NUMBER OF 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. 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 90 th day after the date of filing. FILING FEE The filing fee for this document is $15.00. Checks should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS Alison Lundergan Grimes 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 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. (01/12) American LegalNet, Inc. www.FormsWorkFlow.com