COMMONWEALTH OF KENTUCKY
TREY GRAYSON
SECRETARY OF STATE
APPLICATION FOR REGISTRATION OF FOREIGN BUSINESS TRUST
Pursuant to the provisions of KRS Chapter 386, the undersigned hereby applies for registration on behalf of the
business trust named below and for that purpose submits the following statements:
1. The name of the business trust is
___________________________________________________________________________________.
2. ___________________________ is the state or country of establishment.
3. ___________________________ is the date of establishment.
4. The name of the registered agent is
___________________________________________________________________________________
and the street address of the registered office in Kentucky is
___________________________________________________________________________________.
Street
City
State
Zip Code
5. The address of the principal office is
___________________________________________________________________________________.
Address
City
State
Zip Code
6. The name and the business address of each trustee is
_______________________________________
_____________________________________________________
Name
Address
_______________________________________
_____________________________________________________
Name
Address
_______________________________________
_____________________________________________________
Name
Address
(Attach a continuation sheet, if necessary)
7. A duly authenticated copy of the declaration of trust accompanies this application.
_________________________________________
Signature
_________________________________________
Type or Print Name & Title
Date: ___________________________, 20_______
FBT-100 (2/98)
(See attached sheet for instructions)