Kentucky Secretary of State TREY GRAYSON _________________________________________________________________________________________________ Division of Corporations BUSINESS FILINGS P.O. Box 718 Frankfort, KY 40602 (502) 564-2848 http://www.sos.ky.gov/ Statement of Change of Principal Office Address POC ________________________________________________________________________ Pursuant to the provisions of KRS chapter 271B, 273, 275, or 362, the undersigned hereby applies to change the principal office address on behalf of ________________________________________________________________________________ (Name of Entity) 1. Address of current principal office 2. Principal office is hereby changed to _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ 3. Signature of manager or member _________________________________ Signature and title _________________________________ Type or print name and title _________________________________ Date NUMBER OF COPIES Submit the original signed statement and two exact or conformed copies (may be photocopies). Two file stamped copies will be returned to the organization as evidence of filing. One file-stamped copy must then be filed with the county clerk of the county in which the organization’s registered office is situated. FILING FEES The filing fee for profit corporations, limited liability companies, limited partnerships, and limited liability partnerships is $10.00. The filing fee for nonprofit corporations is $5.00. Your check should be made payable to “Kentucky State Treasurer”. NOTE: The organization must be in “good standing” upon the records of the secretary of state before current statements or documents can be filed (30 KAR 1:010) SPC (09/07) American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com