Kentucky Secretary Of State

1679729803
Kentucky secretary of state

File Name: FBE-Certificate of Authorization_Foreign Business Entity.pdf

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COMMONWEALTH OF KENTUCKY
MICHAEL G. ADAMS, SECRETARY OF STATE
_____________________________________________________________________________________________________
Division of Business Filings Certificate of Authority FBE
P.O. Box 718
Frankfort, KY 40602 (Foreign Business Entity)
(502) 564-3490
www.sos.ky.gov
Pursuant to the provisions of KRS 14A – 030 the undersigned hereby applies for authority to transact business in Kentucky on behalf of the entity named below
and, for that purpose, submits the following statements:
1. The entity is a: profit corporation nonprofit corporation professional limited liability company
business trust limited liability company statutory trust
limited partnership ltd cooperative association other
non-profit llc professional service corporation
2. The name of the entity is_______________________________________________________________________________________________________

(The name must be identical to the name on record with the Secretary of State.)
3. The name of the entity to be used in Kentucky is (if applicable):_________________________________________________________________________

(Only provide if "real name" is unavailable for use; otherwise, leave blank.)
4. The state or country under whose law the entity is organized is_________________________________________________________________________

5. The date of organization is _______________________________________and the period of duration is ____________________________________

(If left blank, duration is considered perpetual.)
6. The mailing address of the entity’s principal office is
_______________________________________________________________ _________________________ _______________ _____________________

Street Address City State Zip Code
7. The street address of the entity’s registered office in Kentucky is
_______________________________________________________________ _________________________ _KY__________________________ ___
Street Address (No P.O. Box Numbers) City State Zip Code
and the name of the registered agent at that office is ___________________________________________________________________________________

8. The names and business addresses of the entity’s representatives (secretary, officers and directors, managers, trustees or general partners):
_______________________________ ________________________________ ________________________ _______________ _____________________
Name Street or P.O. Box City State Zip Code
________________________________ _______________________________ ________________________ ________________ ____________________
Name Street or P.O. Box City State Zip Code
________________________________ _______________________________ ________________________ ________________ ____________________
Name Street or P.O. Box City State Zip Code
9. If a professional service corporation, all the individual shareholders, not less than one half (1/2) of the directors, and all of the officers other than the secretary
and treasurer are licensed in one or more states or territories of the United States or District of Columbia to render a professional service described in the
statement of purposes of the corporation

10. I certify that, as of the date of filing this application, the above-named entity validly exists under the laws of the jurisdiction of its formation

11. If a limited partnership, it elects to be a limited liability limited partnership. Check the box if applicable:
12. If a limited liability company, check box if manager-managed:
13. This application will be effective upon filing

_____________________________________________ _______________________________ _________________________
Signature of Authorized Representative Printed Name & Title Date
I, _________________________________________________________, consent to serve as the registered agent on behalf of the business entity

Type/Print Name of Registered Agent
______________________________________ _________________________ _________________________ ____________
Signature of Registered Agent Printed Name Title Date
(1/20)
FILING INSTRUCTIONS
APPLICATION FOR CERTIFICATE OF AUTHORITY FOR A FOREIGN BUSINESS ENTITY
TYPE OF FORMATION
The business entity must indicate its type pursuant to the provisions of KRS14A-030 by checking the appropriate box

NAME
The business entity name must be exactly as written in the home state and comply with the ending requirements of KRS 14A.3-010

DATE OF ORGANIZATION AND DURATION
The date of organization is the date the business entity filed with the secretary of state or other official having custody of corporate records

The period of duration of the business entity is that period which is stated in the organization filing. (May be perpetual or a total number of years.)
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 a street address (a PO Box is insufficient for the registered office address). In order
to transact business in Kentucky, the registered agent shall be an individual resident of Kentucky, a Kentucky domestic corporation, a Kentucky domestic non-
corporation, a Kentucky domestic limited liability company, a foreign corporation, a foreign non-corporation or a foreign limited liability company authorized to
transact business in Kentucky. The registered agent is the individual or business designated to receive service of process in the event the business is party to a
legal action. The company seeking formation shall not act as its own registered agent

CONSENT OF REGISTERED AGENT
Unless the registered agent signs the form, the business entity must deliver with the certificate of authority, the registered agent’s consent to the appointment

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

EFFECTIVE DATE AND TIME
The document will be effective on the date and time of filing

WHO MAY SIGN
The document must be signed by an officer, chairman of the board, member, manager, trustee or a partner

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

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

FILING FEE
The filing fee is $90.00 for all business entity types. Checks should be made payable to the "Kentucky State Treasurer."
MAILING ADDRESS OFFICE LOCATION
Michael Adams Room 154, Capitol Building
Secretary of State 700 Capital Avenue
P.O. Box 718 Frankfort, KY 40601
Frankfort, KY 40602-0718 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

FUTURE DOCUMENTATION REQUIREMENTS AND DEADLINES
The business entity must file an annual report with the Secretary of State between January 1 and June 30 of the year following the calendar year in which the
corporation was formed. Subsequent annual reports must be filed with the Secretary of State between January 1 and June 30 of the following calendar years

A statement of change of the registered agent and/or registered office address or principal office address must be filed with the Secretary of State whenever a
change has occurred involving any of the above categories. Downloadable forms may be found on our website

Division of Business Filings P.O. Box 718 Frankfort, KY 40602 (502) 564-3490 www.sos.ky.gov Pursuant to the provisions of KRS 14A – 030 the undersigned hereby applies for authority to transact business in Kentucky on behalf of the entity named below and, for that purpose, submits the following statements: 1.

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