WWW.BUSINESSREGISTRATIONS.COM Nonrefundable Filing Fee: $10.00 STATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS Business Registration Division 335 Merchant Street Mailing Address: P.O. Box 40, Honolulu, Hawaii 96810 Phone No. (808) 586-2727 FORM X-1 11/2013 *X1* APPLICATION FOR RESERVATION OF NAME (Section 414-52, 414D-62, 425-8, 425E-109, 428-106, Hawaii Revised Statutes) PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK Please check current or proposed business entity type (check only one): Corporation (F/$10/B20, SH/S04) Partnership (General/Limited/LLLP) (F/$10/B20, SH/S04) LLC (F/$10/L20, SH/S21) 1. 2. 3. Name of Applicant: Address of Applicant: Status of Applicant (check only one): a. Person intending to organize or change name of a domestic business entity. b. Person intending to organize or change name of a foreign business entity. 4. Name to be reserved: (See instruction No. 4 on reverse side) Reserved name includes a fictitious name for a foreign LLC, corporation or limited partnership 5. 6. For Corporations, name is reserved for (check one): For Partnerships, name is reserved for (check one): Profit General Nonprofit Limited Partnership LLLP I certify that I have read the above statements, I am authorized to sign this application, and that the above statements are true and correct to the best of my knowledge and belief. (Print Name) By (Signature) (SEE INSTRUCTIONS ON REVERSE SIDE) --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------(Department Use Only) ___________________________________________________ (Date) Reservation of business entity name, as requested, hereby approved for a period of 120 days to expire at 12:00 midnight on ______________________________________. DIRECTOR OF COMMERCE AND CONSUMER AFFAIRS By________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com FORM X-1 11/2013 Instructions: Application must be typewritten or printed in black ink, and must be legible. All signatures must be in black ink. Submit original application and together with the appropriate fee(s). Only one name may be reserved with each application. Line 1. Name of the applicant must be stated, even though the application may be signed by the applicant's agent. Line 2. Address of applicant may be either a street address or a P. O. Box address. You must state the complete address (including number, street, city, state, and zip code). Line 3. Status of Applicant (check only one). If the business entity is changing its name, the applicant's name on line 1 should state the current name of the business entity before it changes its name. Line 4. Name to be reserved must be clearly stated, with desired punctuation marks. Check the box, if the reserved name includes a fictitious name for a foreign LLC, corporation or limited partnership name. For domestic profit corporations, the reserved name must contain the word: Corporation, Incorporated, or Limited, or the abbreviation of one of the words, Corp., Inc., or Ltd. For domestic limited liability company, the reserved name must contain the phrase: Limited Liability Company or the abbreviation L.L.C., or LLC. Limited may be abbreviated as Ltd., and Company may be abbreviated as Co. For domestic limited partnership, the reserved name must contain the phrase: Limited Partnership or the abbreviation LP or L.P. For domestic limited liability limited partnership, the reserved name must contain the phrase: Limited Liability Limited Partnership or the abbreviation LLLP or L.L.L.P. Filing Fees: Filing fee ($10.00) is not refundable. Make checks payable to DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS. Dishonored Check Fee $25.00. For any questions call (808) 586-2727. Neighbor islands may call the following numbers followed by 6-2727 and the # sign: Kauai 274-3141; Maui 984-2400; Hawaii 974-4000, Lanai & Molokai 1-800-468-4644 (toll free). Fax: (808) 586-2733 Email Address: breg@dcca.hawaii.gov NOTICE: THIS MATERIAL CAN BE MADE AVAILABLE FOR INDIVIDUALS WITH SPECIAL NEEDS. PLEASE CALL THE DIVISION SECRETARY, BUSINESS REGISTRATION DIVISION, DCCA, AT 586-2744, TO SUBMIT YOUR REQUEST. ALL BUSINESS REGISTRATION FILINGS ARE OPEN TO PUBLIC INSPECTION. (SECTION 92F-11, HRS) American LegalNet, Inc. www.FormsWorkFlow.com