F0110 - Page 1 of 1 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1333 Application for Name Reservation *0110-1-1* 1. Type of Corporation Mississippi Limited Liability Company Mississippi Professional Limited Liability Company Foreign Limited Liability Company Foreign Professional Limited Liability Company 2. Limited Liability Company name to reserve 3. Name of applicant 4. Address City, State, ZIP5, ZIP4 - 5. Dated By: Signature (Please keep writing within blocks) Printed Name Rev. 01/96