Arkansas Secretary of State Mark Martin 1401 W. Capitol, Suite 250, Little Rock, AR 72201 501-682-3409 � www.sos.arkansas.gov Application for Reservation of Entity Name Instructions: Mail to Secretary of State's Business and Commercial Services Division, 1401 W. Capitol, Suite 250, Little Rock, Arkansas 72201. A file stamped copy, noting expiration date will be returned for your files. The owners of a reserved name may transfer the reservation to another person by delivering to the Secretary of State a signed notice of the transfer that states the name and address of the transferee. The transfer shall be effective for the duration of the reservation. Jurisdiction (Select One) Domestic Foreign Entity Type (Select One) For-Profit Corporation (Act 958 of 1987 or A.C.A � 4-27-402 non-renewable) Nonprofit Corporation (Act 1147 of 1993 or A.C.A � 4-33-402 non-renewable) LLC (Act 104 of 1993 or A.C.A � 4-32-104 with 1 renewal in 120 days) The undersigned, pursuant to the provisions of the appropriate Act listed above, hereby requests that the following name be reserved for a 120 day period. ________________________________________________________________________________________________________________ Name To Be Reserved ________________________________________________________________________________________________________________ Address City , State Zip I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days. Witness the hand and seal of the applicant executed under oath, on this the ______ day of ____________, ______________. ______________________________________________________ Typed or Printed Name of Applicant _______________________________________________ Signature of Applicant American LegalNet, Inc. www.FormsWorkFlow.com $25.00 Filing Fee payable to Arkansas Secretary of State RN-06/ Rev. 07/15