NR 52-01 CONTACT: KANSAS SECRETARY OF STATE Temporary Reservation of Business Entity Name Kansas Secretary of State, Chris Biggs Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 i (785) 296-4564 kssos@kssos.org www.kssos.org Above space is for office use only. All information must be completed or this document will not be accepted for filing. Please read instructions before completing. INSTRUCTIONS: 1. The undersigned reserves the following entity name: Entity name to be reserved _____________________________________________________________________________________________ 2. Name of applicant: _____________________________________________________________________________________________ 3. Address of the applicant: ________________________________________________________________________________________ Address _______________________________________________________________________________________ City State Zip Country ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ Signature of applicant Name of signer (printed or typed) Date (month, day, year) Phone number ________________________________________________________ Title Save time and money by filing your name reservation online at www.kssos.org i Instructions: 1. Submit this form with the $35 filing fee. Make checks payable to the Kansas Secretary of State. 2. The name reservation is effective for 120 days. This is not a name registration. It is a method to temporarily reserve an entity name until you are ready to file a formation document for the entity. 3. Name reservations may not be renewed. If a reservation is submitted prior to the expiration of a current name reservation, the new reservation will be rejected. 4. The original applicant may transfer the right to a reserved name by filing a written notice of such transfer. The notice should include the name and address of the transferee (new applicant). STAY UP-TO-DATE ON YOUR ORGANIZATION’S STATUS, ANNUAL REPORT DUE DATE AND CONTACT ADDRESSES BY GOING TO WWW.KSSOS.ORG. UNDER QUICK LINKS, SELECT SEARCH BUSINESS ENTITY INFORMATION. NOTICE: There is a $25 service fee for all checks returned by your financial institution. All information must be completed or this document will not be accepted for filing. Rev. 9/01/10 nr Page 1 of 1 K.S.A. 17-7402 American LegalNet, Inc. www.FormsWorkFlow.com