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State of New Hampshire
Form 3 RSA 293-A:4.02 (c)

Filing fee: $l5.00 Use black print or type. Leave 1" margins on both sides.

NOTICE OF TRANSFER OF RESERVED NAME OF

PURSUANT TO THE PROVISIONS OF THE NEW HAMPSHIRE REVISED STATUTES ANNOTATED, YOU ARE HEREBY NOTIFIED THAT THE UNDERSIGNED HAS TRANSFERRED TO WHOSE ADDRESS IS THE ABOVE NAME WHICH WAS RESERVED IN YOUR OFFICE FOR THE EXCLUSIVE USE OF THE UNDERSIGNED ON TWENTY DAYS THEREAFTER. FOR A PERIOD OF ONE HUNDRED

(Note 1) (Print name of original applicant)

(No. and Street)

(City/Town) (State) (Zip Code)

(Email Address)

(Telephone Number)

Its
Signature (Note 2) Title

Date signed:
Print or type name

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 Corporate Division become public records and will be available for public inspection in either tangible or electronic form. Mail fee with DATED AND SIGNED ORIGINAL to: Corporate Division, Department of State, 107 North Main Street, Concord NH 03301-4989.
3/08 Form 3 V-1.0