FILING INSTRUCTIONS
CANCELLATION OF STATEMENT OF QUALIFICATION
NAME
Use the exact name of the business entity as registered on file with the Office of the Secretary of State.
DATE OF FILING
Give the date the statement of qualification was filed with the Secretary of State.
EFFECTIVE DATE AND TIME/DELAYED EFFECTIVE DATE AND TIME
The document will be effective on the date and time of filing, unless a delayed effective date and/or time is specified. The effective date or the delayed
th
effective date cannot be prior to the date the application is filed. A delayed effective date may not be later than the 90
day after the date of filing.
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.
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.
WHO MAY SIGN
The document must be signed by a partner or other person authorized to act on behalf of the partnership.
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 and print a copy from the organization search tool.
FILING FEE
The filing fee for this document is $40.00. Checks should be made payable to the "Kentucky State Treasurer."
MAILING ADDRESS
OFFICE LOCATION
Elaine N. Walker
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 or call 502-564-3490.
(04/11)