BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July, 2017) (Form BE-14) STATE OF NORTH CAROLINA DEPARTMENT OF THE SECRETARY OF STATE APPLICATION TO RESERVE A BUSINESS ENTITY NAME (10-Year Reservation) Pursuant to 24755D-23(c) of the General Statutes of North Carolina, the undersigned hereby applies to the Secretary of State to reserve the following entity name: 1. The entity name to be reserved is: Entity Type: Domestic Corporation, Foreign Corporation, Domestic Nonprofit Corporation, Foreign Nonprofit Corporation, Domestic Limited Liability Company, Foreign Limited Liability Company, Domestic Limited Partnership, Foreign Limited Partnership, Domestic Limited Liability Partnership, Foreign Limited Liability Partnership. 2. The name of the applicant is: 3. The address of the applicant is: Street Address City: State: Zip Code: 4. The applicant has acquired the goodwill of a domestic or foreign corporation, domestic or foreign limited liability company, a domestic or foreign limited partnership, or a domestic or foreign registered limited liability partnership authorized to transact business in the State of North Carolina. (Satisfactory evidence of the acquisition of the goodwill of such entity must be furnished to the Secretary of State along with this Application.) a. The name of the entity whose goodwill was acquired is: b. State of incorporation or formation: 5. The above entity name is to be reserved for a period of 10 years from the date of the filing of this application. This the day of , 20. Name of Entity Signature Type or Print Name and Title NOTES: 1. Filing fee is $10. This document must be filed with the Secretary of State. 2. This form may only be used by a person that has acquired the goodwill of a domestic or foreign entity authorized to transact business or conduct affairs in the State of North Carolina. American LegalNet, Inc. www.FormsWorkFlow.com