Expedite this Form: (Select One) Prescribed by: Mail Form to one of the Following: The Ohio Secretary of State Central Ohio: (614) 466-3910 Toll Free: 1-877-SOS-FILE (1-877-767-3453) Yes PO Box 1390 Columbus, OH 43216 *** Requires an additional fee of $100 *** No PO Box 1329 Columbus, OH 43216 www.sos.state.oh.us e-mail: busserv@sos.state.oh.us ASSIGNMENT AND APPLICATION FOR EXCLUSIVE RIGHTS OF A NAME TO A BUSINESS TRUST (For Domestic or Foreign) (1) Assignment of Name of Business Trust Registration No. (2) Application for Exclusive Right to Name of Business Trust (119-BSA) (118-BTN) Filing Fee $25.00 Filing Fee $50.00 Complete the information in this section if box (1) is checked. The undersigned, being the owner of record of the reserved corporate name, reserved business trust name, or business trust name to which it has exclusive right, for the sum of One ($1.00) Dollar and other valuable consideration paid to me, do hereby sell, assign, and transfers all right, title and interest in said name to: New Registrant's Name & Address (Name) (Street) NOTE: P.O. Box Addresses are NOT acceptable. (City) (State) (Zip Code) Registration No. Must be authenticated by an authorized representative Authorized Representative Date American LegalNet, Inc. www.FormsWorkflow.com 544 Page 1 of 2 Last Revised: Jan. 2002 Complete the information in this section if box (2) is checked. The Applicant, a business trust NOT having made the filings described under section 1746.04 of the ORC hereby declares that: The exact name to be registered is: The complete Ohio address of the principal office of the business trust is: The date, if any, upon which the business trust began engaging in business in Ohio is: (date) The general nature of the business in which the business trust is engaged is: The period of existence of the business trust, as stated in the trust instrument, expires on: (date) The applicant business trust agrees to file in the office of the Secretary of State a written transfer stating the name and address of the transferee, if it transfers the right to the exclusive use of the name applied for above. The undersigned, being first duly sworn, state that I am a trustee of the applicant and verify that the above declarations are true to the best of my knowledge and belief. Signature: (trustee) Sworn to before me and subscribed in my presence (date) Signature: (SEAL) Name: (notary public) Expiration Date: (date) American LegalNet, Inc. www.FormsWorkflow.com 544 Page 2 of 2 Last Revised: Jan. 2002 Instructions 1. Use Tab key to move between entry fields American LegalNet, Inc. www.FormsWorkflow.com