MINNESOTA SECRETARY OF STATE REQUEST FOR RESERVATION OF NAME I hereby request the Secretary of State to reserve the name listed below. I understand that the name reservation does not register the business name, and is valid for twelve months from the date on which it is filed. The name reservation may be renewed for additional twelve month periods, pursuant to MN Statutes, 302A.117, 317A.117, 322B.125 or 321.109. READ INSTRUCTIONS BEFORE COMPLETING THIS FORM Filing Fee: $35.00 1. Desired Name: (Required) ______________________________________________________________________ 2 Reserved For: (Required) _______________________________________________________________________ Note: If this name is reserved for an organization not yet formed, list the individual who will be signing the documents, which will be submitted at the time of the organization of the business. 3. Located at: (Required) _________________________________________________________________________ (Street Address) __________________________________________________________________________ (City) (State) (Zip) 4. The applicant hereby states that the proposed name holder is: a. b. c. d. A person doing business in this state under that name or a deceptively similar name; A person intending to form an entity under Chapter 302A, 317A, 322B or 321; A domestic corporation, limited liability company or limited partnership intending to change its name; A foreign corporation, foreign limited liability company or foreign limited partnership intending to make application for a Certificate of Authority to transact business or register in this state; e. A foreign corporation, foreign limited liability or foreign limited partnership authorized to transact business in this state and intending to change its name; f. A person intending to incorporate a foreign corporation, or foreign limited liability company and intending to have the foreign corporation, or foreign limited liability company make application for a Certificate of Authority to transact business in this state; a person registering as a foreign limited partnership; or g. A foreign corporation, foreign limited liability company or foreign limited partnership doing business under that name or a name deceptively similar to that name in a state other than Minnesota and not described in clauses d, e or f. I certify that the foregoing is true and accurate and that I have the authority to sign this document on behalf of the proposed name holder, and I further certify that I understand that by signing this reservation, I am subject to the penalties of perjury as set forth in section 609.48 as if I had signed this reservation under oath. 5. Signature: (Required) __________________________________Position: ___________________________________ 6. Name, daytime telephone number and e-mail address of contact person: Name: __________________________________Phone:(___)______________________Ext. ________ E-Mail Address: ______________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK 1. Desired Name: (Required) List the Name to be Reserved. 2. Reserved For: (Required) List the Name Holder for the Name Reservation. If this name is reserved for an organization not yet formed, list the individual who will be signing the documents, which will be submitted at the time of the organization of the business. 3. Located at: (Required) List the address where the holder of the name is located. 4. Information must be provided as part of Name Reservation. 5. Signature and Position: (Required) Authorized signature and position (if applicable). 6. Name, daytime telephone number and e-mail address of contact person for the corporation: Please list a name, daytime telephone number and an e-mail address of a person who can be contacted about this form. Filing Fee: $35.00 Payable to the MN Secretary of State. FILE IN-PERSON OR MAIL TO: Minnesota Secretary of State - Business Services Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St Paul, MN 55103 (Staffed 8:00 - 4:00, Monday - Friday, excluding holidays) To obtain a copy of a form you can go to our web site at www.sos.state.mn.us , or contact us between 9:00am to 4:00pm, Monday through Friday at (651) 296-2803 or toll free 1-877-551-6767. All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If that information is not included, your document may be returned unfiled. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-6273529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of service. bus2 Request For Reservation Of Name Rev. 06-07 American LegalNet, Inc. www.FormsWorkflow.com