Name/DBA Fictitious Business Name Notice

KENTUCKY CERTIFICATE OF ASSUMED NAME WORKSHEET

1. FILING ROUTE

Kentucky requires a person or covered business organization using an assumed name rather than its statutory "real name" to file a certificate under Ky. Rev. Stat. § 365.015.

• Individual / sole proprietor: file with the county clerk for the person's principal place of business.
• General partnership, limited partnership, business or statutory trust, corporation, limited liability company, or limited cooperative association: file with the Secretary of State and then file a stamped copy with the county clerk where the entity maintains its registered agent. If no registered agent is required, use the county of the principal office. If neither is in Kentucky, the filing is only with the Secretary of State.

2. CERTIFICATE INFORMATION

Assumed Name: [NAME]

Registrant's Real Name: [LEGAL NAME]

Registrant Type: [INDIVIDUAL / ENTITY TYPE]

Mailing Address: [STREET AND NUMBER, CITY, STATE, ZIP]

Jurisdiction of Organization (entity): [JURISDICTION]

Kentucky Organization Number (if any): [NUMBER]

2.1 File a separate certificate for each assumed name.

2.2 A certificate submitted to the Secretary of State must use a name distinguishable on the Secretary's records.

2.3 Use the current official certificate and authorized signature rules. The Secretary's July 2025 entity form uses a declaration under penalty of perjury and does not require the optional newspaper notice or notary block found in the prior template.

3. TERM AND RENEWAL

3.1 An assumed-name certificate is effective for five years from filing.

3.2 Renew for another five-year term by filing the renewal certificate during the six months before expiration, following the same office-routing rules as the original filing.

Calendar:

• Filing date: [DATE]
• Expiration date: [DATE]
• Six-month renewal window opens: [DATE]

4. AMENDMENT AND WITHDRAWAL

4.1 A general partnership other than an LLP must amend its certificate when partner identity changes. A certificate may also be amended to revise the holder's real name or address.

4.2 Upon discontinuing use of the assumed name, file a withdrawal in each office where the original certificate was filed. The statute does not impose the generic 60-day withdrawal deadline stated in the prior template.

4.3 Filing does not automatically prevent others from using the assumed name or protect the name against others.

5. FEES AND PUBLICATION

5.1 Section 365.015 states a $20 Secretary of State fee for a certificate, amendment, or renewal; the county clerk charges the fee under Ky. Rev. Stat. § 64.012. Confirm current payment instructions at filing.

5.2 Kentucky's statewide assumed-name statute and current Secretary of State forms reviewed for this template do not require newspaper publication.

6. SIGNATURE

I declare under penalty of perjury under Kentucky law that the information on the official certificate is true and correct.

__________________________________________

Printed Name: [NAME]

Title / Capacity: [TITLE]

Date: [DATE]

7. PRACTITIONER NOTES

• This worksheet creates no six-year record-retention rule, administrative-inactive remedy, exclusivity warranty, private cure period, or exclusive county forum.
• Use the Secretary's separate amendment, renewal, or withdrawal form when applicable.

SOURCES AND REFERENCES

• Kentucky Legislature — Ky. Rev. Stat. § 365.015
• Kentucky Secretary of State — Certificate of Assumed Name
• Kentucky Secretary of State — Renewal of Assumed Name