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

TRANSFER OF RESERVED NAME For Domestic or Foreign Stock & Non-Stock Corp, LLC, LP, LLP & Statutory Trust
C.G.S. §§ 33-656; 33-1046; 34-103; 34-139; 34-407; 34-506

FILING FEE: $30.00

Make checks payable to "Secretary of the State"

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

06115-0470

USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. (Attach 8 ½ x 11 sheet if necessary) The undersigned transferor hereby transfers rights associated with following reserved name to the transferee named below: 1. Reserved Name: 2. Name of Transferor: 3. Name of Transferee: 4. Address of Transferee: (Complete address required. Street name, city, state and zip code.) CONNECTICUT SECRETARY OF THE STATE _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ 5. Execution: If transferor is an individual: Signature

If transferor is a business: Signature Print Name

Print Title Note: The transferred reservation will be effective for the remaining balance of the transferor's 120 day reservation period. Please type or print all information other than the signature. · · 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 06/19/09