FORM BCA 4.10 (rev. Aug. 2014) APPLICATION FOR RESERVATION OF NAME Business Corporation Act Secretary of State Department of Business Services 501 S. Second St., Rm. 350 Springfield, IL 62756 217-782-9520 217-782-6961 www.cyberdriveillinois.com Print Reset Save Payment must be made by check or money order payable to Secretary of State. ($25 fee to each name reserved.) 1. Name(s) to be Reserved (for a period of 90 days each): -------- Submit in duplicate -------- Type or Print clearly in black ink -------- Do not write above this line -------- Filing fee $ _________________________ File # ___________________________ Approved: _________________ _____________________________________________________________________________________________ 2. Proposed Corporate Purpose: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 3. Name of Applicant: ______________________________________________________________________________ 4. Address of Applicant: ____________________________________________________________________________ _____________________________________________________________________________________________ Month Day Year _____________________________________________________________________________________________ Must contain the word "corporation," "company," "incorporated" or "limited," or contain an abbreviation of such words. 5. Dated _______________________________ , _____ ______________________________________________ ______________________________________________ Signature of Applicant Name (type or print) NOTE: · If the applicant is an individual, this application must be signed by the applicant. · If the applicant is a corporation, this application must be signed by a duly authorized officer of the corporation. · Upon filing of this document, name(s) will be reserved for a period of 90 days. Printed by authority of the State of Illinois. January 2015 -- 1 -- C 156.10 NOTICE OF TRANSFER OF RESERVED NAME Date: Filing Fee: $25 Approved: The undersigned _____________________________________________________________________ hereby transfers to _______________________________________________________________________________ the right to use the name __________________________________________________________________________for corporate purposes in Illinois. This name was reserved on ____________________________________, __________. Month Day Year Name of Transferee Name of Original Applicant The undersigned affirms, under penalties of perjury, that the facts stated herein are true and correct. Dated _______________________________ , ______ Month Day Year Attested by __________________________________ by _________________________________________ _________________________________________ Name (type or print) Signature of Original Applicant * As the original applicant, I declare that this document has been examined by me and is to the best of my knowledge and belief, true, correct and complete. American LegalNet, Inc. www.FormsWorkFlow.com