Notes: 1. Enter name of individual or name of business entity in whose name certificate of reservation was issued and address. 2. Signature of original applicant. DISCLAIMER: All documents filed with the Corporation Division become public records and will be available for public inspection in either tangible or electronic form. PURSUANT TO THE PROVISIONS of the New Hampshire Revised Statutes Annotated, you are hereby whose address is the above name which was reserved in your office for the exclusive use of the undersigned on for a period of one hundred twenty days thereafter. (Print name of original applicant) (No.) (Street) (City/Town) (State) (Zip Code) [Signature (Note 2)] (Email Address) (Print or type name) (Telephone Number) Date signed: (Title) American LegalNet, Inc. www.FormsWorkFlow.com