Form Csq - Cancellation Of Statement Of Qualification For A Limited Liability Partnership - Kentucky Secretary Of State Page 2

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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

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