APPLICATION FOR FICTITIOUS NAME Select entity type: For-Profit Corporation($25.00 fee)General Partnership ($15.00 fee)LLC ($25.00 fee)LLLP($15.00 fee) Pursuant to the provisions of Arkansas law, the undersigned entity hereby applies for the use of a fictitiousname and submits herewith the following statement: The fictitious name under which the business is being, or will be, conducted by this entity is:The character of the business being, or to be, conducted under such fictitious name is:a) The entity name of the applicant and its date of qualification in Arkansas: b)The entity is (state of domestic registration) c)The location (city and street address) of the registered office of the applicant entity in Arkansas is: StreetCityStateZIPCode I understand that knowingly signing a false document with the intent to file with the ArkansasSecretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or impris-onment up to 30 days.Authorizing Officer (Type or Print) Authorized Signature: (Chairman, Partner or other authorized person) Address: INSTRUCTIONS: File with the Secretary of State's Office, Business Services Division, State Capitol, Little Rock,Arkansas 72201-1094. Acopy will be returned to the entity and must be filed with the County Clerk in the coun-ty in which the entity!s registered office is located (unless registered office is in Pulaski County). 001027021n024030n030007r013027r031n027035025016007031n031r$'#$t 003n026020031025022037004020031031022r006025013021 Nonprofit Corporation($25.00 fee)Limited Partnership ($15.00 fee)LLP($15.00 fee) American LegalNet, Inc. www.FormsWorkFlow.com