Document Processing Fee If document is on paper: If document is filed electronically: Fees are subject to change. $10.00 $ .99 For electronic filing and to obtain copies of filed documents visit www.sos.state.co.us Deliver paper documents to: Colorado Secretary of State Business Division 1560 Broadway, Suite 200 Denver, CO 80202-5169 Paper documents must be typed or machine printed. Instructions for completing a Statement of Reservation of Name Use these instructions when completing a Statement of Reservation of Name pursuant to §7-90-602 and part 3 of Article 90 of Title 7 of the Colorado Revised Statutes (C.R.S.). A reserved name is held for the person’s exclusive use for a one-hundred-twenty-day period, which reservation may be renewed successively for onehundred-twenty-day periods. Provide only information required or permitted to be included in the document by Colorado law. Information included in the document must be typewritten, in English and must state the name(s) and address(es) of at least one individual causing the document to be delivered for filing. The required form/coversheet must be used when filing the document. For legal authority, refer to §7-90-301 and §7-90-302, C.R.S. You may include additional information in an attachment to the form/coversheet. Any attachment becomes part of the document. If there is a conflict between information in the attachment and the form/coversheet, the information in the form/coversheet controls. Information provided in a case-sensitive format will be retrieved and displayed in the same format. Visit our Web site at www.sos.state.co.us and click on “Business Center” for a copy of a document after filing, Certificates of Good Standing, other electronic services, and other information. For answers to general filing questions consult the Frequently Asked Questions (FAQs), also on our Web site. Line-by-line Instructions: Statement Regarding Use of Name. A statement is required that the person stated as the applicant is applying to reserve the name stated for use as an entity name or as a trade name. Trademarks cannot be reserved. Name of Applicant. Provide the name of the person wishing to reserve the name. If the reservation is on behalf of a business organization, indicate the name of the business organization, not the name of the individual(s). The name of the applicant will be verified when the name is used as an entity name or as a trade name. Applicant Mailing Address. List the complete mailing address of the applicant, including zip code. Name to be Reserved. State the name to be reserved. Restricted Words. Inclusion of any of these terms: “bank” or “trust” or any derivative thereof, “credit union”, “savings and loan”, “insurance”, “casualty”, “mutual”, or “surety” may be prohibited or restricted by Colorado law, and may be regulated by other state agencies (for example, use of the term “bank” requires Division of Banking approval). Mark only one box. If more than one term appears in the name, choose the term that best describes the organizational structure of the entity. Notice. Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person on whose behalf the individual is causing the document to be delivered for filing, taken Rev. 7/2/2004 1 of 2 in conformity with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic statutes, and that the individual in good faith believes the facts stated in the document are true and the document complies with the requirements of that Part, the constituent documents, and the organic statutes. This perjury notice applies to each individual who causes this document to be delivered to the secretary of state, whether or not such individual is named in the document as one who has caused it to be delivered. Filing Information. State the name(s) and address(es) of the individual(s) causing this document to be delivered for filing. This information is required for the Colorado Secretary of State to deliver notice if the filing of the document is refused (§7-90-301, C.R.S.). The individual(s) listed will be held responsible for complying with the above notice. The document need not state the true name and address of more than one individual. However, if you wish to state the name and address of any additional individuals causing the document to be delivered for filing, mark this box ‫ ٱ‬and include an attachment stating the name and address of such individuals. Disclaimer. These instructions, and the related form, are not intended to provide legal, business or tax advice, and are offered as a public service without representation or warranty. While the related form is believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form. Questions should be addressed to the user’s attorney. Rev. 7/2/2004 2 of 2 Document processing fee If document is filed on paper $125.00 If document is filed electronically $ 25.00 Fees & forms/cover sheets are subject to change. To file electronically, access instructions for this form/cover sheet and other information or print copies of filed documents, visit www.sos.state.co.us and select Business Center. Paper documents must be typewritten or machine printed. ABOVE SPACE FOR OFFICE USE ONLY Statement of Reservation of Name filed pursuant to §7-90-301, et seq. and §7-90-602 of the Colorado Revised Statutes (C.R.S) 1. The person stated as the applicant below is applying to reserve, for a 120 day period, the name stated below for use as an entity name. 2. Name to reserve: ______________________________________________________ 3. Use of Restricted Words (if any of these terms are contained in an entity name, true name of an entity, trade name or trademark stated in this document, mark the applicable box): 4. Name of applicant (if an individual): “bank” or “trust” or any derivative thereof “credit union” “savings and loan” “insurance”, “casualty”, “mutual”, or “surety” ____________________ ______________ ______________ _____ (Last) OR (if a business organization): 5. Mailing address of applicant: (First) (Middle) (Suffix) ______________________________________________________ ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) (Postal/Zip Code) _______________________ ______________ (Province – if applicable) (Country – if not US) Notice: Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or that the individual in good faith believes the document is the act and deed of the person on whose behalf the individual is causing the document to be delivered for filing, taken in conformity with the requirements of part 3 of article 90 of title 7, C.R.S., the constituent documents, and the organic statutes, and that the individual in good faith believes the facts stated in the document are true and the document complies with the requirements of that Part, the constituent documents, and the organic statutes. This perjury notice applies to each individual who causes this document to be delivered to the secretary of state, whether or not such individual is named in the document as one who has caused it to be delivered. 6. Name(s) and address(es) of the individual(s) causing the document to be delivered for filing: ____________________ ______________ ______________ _____ (Last) RS Page 1 of 2 (First) (Middle) (Suffix) Rev. 5/30/2006 ______________________________________________________ (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (State) _______________________ (Province – if applicable) (Postal/Zip Code) ______________ (Country – if not US) (The document need not state the true name and address of more than one individual. However, if you wish to state the name and address of any additional individuals causing the document to be delivered for filing, mark this box name and address of such individuals.) and include an attachment stating the Disclaimer: This form, and any related instructions, are not intended to provide legal, business or tax advice, and are offered as a public service without representation or warranty. While this form is believed to satisfy minimum legal requirements as of its revision date, compliance with applicable law, as the same may be amended from time to time, remains the responsibility of the user of this form. Questions should be addressed to the user’s attorney. RS Page 2 of 2 Rev. 5/30/2006