===== PAGE 1 =====
# CERTIFICATION OF COMMERCIAL PURPOSE FOR OPEN RECORDS REQUEST

I,  , have made a request under the provisions of the Kentucky Open Records Act for the following information:

I attest that this information is to be used for the following commercial purpose (as defined in KRS 61.870 (4)(a)):



<div style="text-align: center;"><img src="imgs/img_in_image_box_296_909_2261_1255.jpg" alt="Image" width="77%" /></div>


to the benefit of the following entity:



I understand that I may be required to enter into a contract with Kentucky State University, through any of its agencies, in order to obtain this information, which may be provided for the stated commercial purpose for a specified fee. I further understand that, in accordance with K.R.S. 61.874(5), it is unlawful to obtain a copy of any part of a public record for a commercial purpose, if I use or knowingly allow the use of the public record for a use other than that for which I submit this certification, or resell the information to a third party.

WITNESS the certification of purpose of the party hereto by the signature affixed hereon.

By: ___

Title:

<div style="text-align: center;"><img src="imgs/img_in_image_box_291_2145_2301_2881.jpg" alt="Image" width="78%" /></div>


The foregoing document was acknowledged before me this day of,20, to be the true act and deed of said individual and/or entity.



NOTARY PUBLIC

STATE AT LARGE,



My Commission expires: ___