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 Notice of Cancellation of Reserved Name CRN (Limited Liability Company or Limited Partnership) __________________________________________________________________________________________ Pursuant to the provisions of KRS Chapter 275 and 362, the undersigned applicant applies to cancel a reserved name and, for that purpose, submits the following statement: 1. The name reserved was____________________________________________________________________________. 2. The name was reserved by__________________________________________________________________________. 3. The date the name reservation was filed with the Office of the Secretary of State________________________________. 4. The mailing address of the applicant: ___________________________________________________________________________________________________ Street Address or Post Office Box Numbers City State Zip I declare under penalty of perjury under the laws of Kentucky that the forgoing is true and correct. ___________________________________________________________________________________________________ Signature of Applicant (09/09) Printed Name Title Date American LegalNet, Inc. www.FormsWorkFlow.com FILING INSTRUCTIONS NOTICE OF TRANSFER OF CANCELLATION OF RESERVED NAME NAME Use the exact name of the business entity as registered on file with the Office of the Secretary of State. 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 the applicant. NUMBER OF COPIES When filing online with the FastTrack system, no copies are required. 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. FILING FEE The filing fee for this document is $15.00. Checks should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS Trey Grayson Office of the 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 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