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 Statement of Change of Registered Office or Registered Agent or Both RAC ________________________________________________________________________________ Pursuant to the provisions of KRS Chapter 271B, 273, 275, or 362, the undersigned hereby applies to change the registered office of registered agent, or both on behalf of: _____________________________________________________________________________ (The name must be identical to the name on record with the Secretary of State.) which is organized in the state of ______________, and for that purpose submits the following statements: 1. Name of current registered agent: 2. Registered agent is hereby changed to: __________________________________ ___________________________________ 3. Address of current registered office: 4. Registered office is hereby changed to: _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ The street address of the registered office and the business office of the registered agent, as changed, will be identical. 5. Signature of officer, chairman of the board member, manager, or partner _________________________________ Signature and title _________________________________ Type or print name and title _________________________________ Date 6. Consent of registered agent I consent to serve as the registered agent on behalf of this entity: _________________________________ Signature of registered agent _________________________________ Date (09/09) American LegalNet, Inc. www.FormsWorkFlow.com FILING INSTRUCTIONS STATEMENT OF CHANGE OF REGISTERED OFFICE, REGISTERED AGENT OR BOTH NAME Use the exact name of the business entity as registered on file with the Office of the Secretary of State. REGISTERED OFFICE AND REGISTERED AGENT The registered office of the limited partnership 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 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. WHO MAY SIGN The document must be signed by an officer, chairman of the board, member, manager or a partner. NUMBER OF COPIES When filing online with the FastTrack system, 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 this document is $10.00 for profit corporations, limited liability companies, limited partnerships, and limited liability partnerships and $5.00 for non-profit corporations. Checks should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS Trey Grayson 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. (09/09) American LegalNet, Inc. www.FormsWorkFlow.com