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Kentucky Limited Partnership Registered Agent Consent Form

In the case of a limited partnership that is registered in the State of Kentucky wanting to register an agent for itself, the following form has to be completed and submitted to prove the agent’s consent.

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(01/12	) 	
 	
 	
C	OMMONWEALTH OF 	K	ENTUCKY 	 	
A	LISON 	LUNDERGAN 	G	RIMES	, S	ECRETARY OF 	S	TATE	 	
____________________________________________________________________________________________	_____________________________	 	
Division of 	Business Filings	 	
Business Filings	 	
PO Box 718	 	
Fra	nkfort, KY 40602	 	
(502) 564	-3490	 	
www.sos.ky.gov	 	
___________________________________________________________	_______________________________	 	
 
Pursuant to the provisions o	f KRS 14A and 	KRS Chapter 271B, 273, 	274, 	275,	 362	 or 386	, the undersigned 	applicant 	
cons	ents to act as registered agent on behalf of the business entity named below and	, for that purpose	, submits the 	
following statements:	 	
 
 
1.  	The business entity is 	 	 a corporation (KRS 271B	, KRS 273	 or KRS 274	) 	
 	 	 	 	 a limited liability company (KRS 275)	 	
 	 	 	 	 a limited partnership (KRS 362)	 	
 	 	 	 	 a limited liability partnership (KRS 362)	 	
 	 	 	 	 a business trust (KRS 386)	 	
 
2.  	The name of the business entity is 	__________________________________________________________________.	 	
 
3.  	The state or country of i	ncorporation, organi	zation or formation is _	______________________	___________________	. 	
 
4.  	The name of the initial registered agent is	 ____________________________________________________________.	 	
 
5.  	The street address of the registered office address i	n Kentucky is	: 	
 
__________________	_______________________________ ______________ _________________________ __	___	_____________	 	Street Address 	(No 	Post Office Box	 Numbers)	  	 	City	 	 	State	 	 	 	 	Zip Code	 	
 
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 Registered Agent	 	 	 	Printed Nam	e  	 	 	 	Title	 	 	 	 
 
 
 	
 
 
 	
Statement of Consent of Registered Agent	 	 	CRA	  	
(Domestic or Foreign Business Entity	)

(01/12	) 	
 	
FILING INSTRUCTIONS 	 	
STATEMENT OF CONSENT	 REGISTERED AGENT 	 	
 
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  f	ollow  the 	
process pr	escribed in Kentucky Revised Statute.	 	
WHO MAY SIGN 	 	
The document must be signed	 by an individual meeting one of the following requirements	: 	
• 	If the registered agent is an individual resident of this state, the individual must sign statement. 	 	
• 	If 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 vested in one or more managers, a 
manager must sign o	n behalf of the limited liability company.	   If management of the company is vested in its members, a 	
member must 	sign.	 	
• 	If the registered agent is a limited partnership, a general partner must sign on behalf the limited partnership. 	 	
• 	If the registered agen	t is a limited liability partnership the statement shall be executed a partner or other person authorized by 	
chapter 362. 	 	
• 	The representative signing the statement of consent on behalf of the business entity acting as agent must designate the 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  Sta	te  where  the 	
principal designated office of the business entity is lo	cated.  This address is where all correspondence from the Office of the Secretary 	
of State (See Document Delivery) will be 	mailed.	 	
NUMBER OF COPIES	 	
If filing via mail or in person, one exact or conformed copy of the documents with the filing fee must be su	bmitted 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.	 	
 
EFFECTIVE DATE AND TIME	 	
The document will be effective on the date and ti	me of filing, unless a delayed effective date and/or time is specified.  A delayed 	
effective date may not be later than the 90	th day after the date of filing.	 	
 
FILING FEE	 	
There is no filing fee for filing this document.  	Checks should be made payable to th	e "Kentucky State Treasurer."	 	
 
MAILING ADDRESS	 	 	 	OFFICE LOCATION	 	
Alison Lundergan Grimes	  	 	Room 154, Capitol Building	 	
Office of the Secretary of State	 	 	700 Capital Avenue	 	
PO Box 718	 	 	 	 	Frankfort, KY  40601	 	
Frankfort, KY  40602	-0718	  	 	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.
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