Secretary of State Office 500 E Capitol Ave Pierre, SD 57501 (605)773-4845 APPLICATION FOR RESERVATION OF NAME NONPROFIT CORPORATION Please Type or Print Clearly in Ink Please submit one Original and one Photocopy FILING FEE: $20 payable to SECRETARY OF STATE Telephone # ____________________ FAX # _______________________ Pursuant to the provisions of the South Dakota Law, the undersigned hereby applies for reservation of the following name for a period of one hundred twenty (120) days, which period shall not be extended. 1. The name to be reserved is _______________________________________________________________________ ______________________________________________________________________________________________ 2. Check one to indicate how the reserved name is to be used: Incorporation of a domestic nonprofit corporation Domestic nonprofit corporation intending to change its name Foreign nonprofit corporation intending to make application for a Certificate of Authority Foreign nonprofit corporation authorized in this state intending to change its name Any person intending to organize a foreign nonprofit corporation and to have such corporation make application for a Certificate of Authority Dated ____________________________ ______________________________________________ (Signature of the applicant) ______________________________________________ (Printed Name) ______________________________________________ (Title) reservationofnonprofitname July 2008 American LegalNet, Inc. www.FormsWorkflow.com