Free Microsoft Word - app for reserv of name-all entities.DOC - Connecticut

APPLICATION FOR RESERVATION OF NAME For Domestic or Foreign Stock & Non-Stock Corp, LLC, LP, LLP & Statutory Trust

FILING FEE: $30.00

Make checks payable to "Secretary of the State"

C.G.S. §§ 33-655; 33-656; 33-925; 33-1045; 33-1046; 33-1215; 34-13; 34-13a;34-38i;34-102; 34-103;34-227; 34-406; 34-407; 34-506; 34-535 Website Address: www.concord.sots.ct.gov Telephone Number: (860) 509-6003 Mailing Address: Connecticut Secretary of the State, Commercial Recording Division P.O. Box 150470, Hartford, CT Courier Delivery Address ONLY: (i.e. FedEx, UPS, etc.) 30 Trinity Street, Hartford, CT 06106
USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. (Attach 8 ½ x 11 sheet if necessary)

06115-0470

IMPORTANT: A NAME RESERVATION DOES NOT ACTUALLY FORM THE ENTITY. YOU MUST FILE THE APPROPRIATE FORM(S) WITH THIS OFFICE TO FORM/REGISTER YOUR BUSINESS ENTITY. The undersigned hereby applies for reservation of the following name: 1. Name to be reserved-REQUIRED: (Name must include appropriate business/entity designation-see instructions) 2. Name of applicant-REQUIRED: 3. Address of applicant: (Complete address required. Street name, city, state & zip code.) _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ 4. Execution-REQUIRED: ______________________________________________________________________________ SIGNATURE OF APPLICANT (print name and title, if applicable) The reservation will be effective for a period of 120 days from file date. File date is day one. At the end of the 120th day, the Name Reservation expires. · · Contact your tax advisor or the Taxpayer Service Center at the Department of Revenue Services as to any potential tax liability relating to your business, including questions about the Business Entity Tax. Taxpayer Service Center: (800) 382-9463 or (860) 297-5962 or go to www.ct.gov/drs

Revised 6/19/09

CONNECTICUT SECRETARY OF THE STATE

APPLICATION FOR RESERVATION OF NAME For Domestic or Foreign Stock & Non-Stock Corp, LLC, LP, LLP & Statutory Trust

C.G.S. §§ 33-655; 33-656; 33-925; 33-1045; 33-1046; 33-1215; 34-13; 34-13a;34-38i;34-102; 34-103;34-227; 34-406; 34-407; 34-506; 34-535

FILING FEE: $30.00 Make checks payable to "Secretary of the State" INSTRUCTIONS 1. NAME: Please provide the name which you intend to reserve. You may reserve for exclusive use the name of one of the following types of business organizations or entities: A corporation (stock & non-stock), limited liability company, limited partnership, limited liability partnership or statutory trust. The name which you reserve must contain the appropriate statutory designation which denotes the type of entity or organization for which the name is intended to be used. Choose a statutory designation from the selection below according to organization type and include it within the name as it appears in block 1 on the form. CORPORATE DESIGNATIONS The name of a corporation must contain one of the following designations: corporation, incorporated, company, Societa per Azioni, limited or the abbreviations corp., inc., co., S.p.A. or ltd. LIMITED LIABILITY COMPANY DESIGNATIONS The name of a limited liability company must contain one of the following designations: Limited Liability Company, L.L.C., LLC, Limited Liability Co., Ltd. Liability Company or Ltd. Liability Co. LIMITED PARTNERSHIP DESIGNATIONS The name of a Limited Partnership must contain, without abbreviation; the words limited partnership. LIMITED LIABILITY PARTNERSHIP DESIGNATIONS The name of a limited liability partnership must contain one of the following designations: Registered Limited Liability Partnership, Limited Liability Partnership, L.L.P., or LLP as its last words or letters. STATUTORY TRUST DESIGNATION The name of a statutory trust must contain one of the following designations: Statutory Trust, Limited Liability Trust, Limited, LLT, L.L.T., or Ltd. 2. 3. 4. NAME OF APPLICANT: Please print or type the name of the applicant. ADDRESS OF APPLICANT: Please provide the street address of the applicant including street number, street name, city, state and postal code. EXECUTION: Please print or type the complete legal name of the signatory, title (if signing on behalf of an entity) and signature. Note that the execution constitutes a statement made under the penalties of false statement that the information provided in the document is true.

Revised 9/29/08