Free Application for Reservation of Name - Illinois

Form

NFP 104.10
(Rev. Jan. 2003) Jesse White Secretary of State Department of Business Services Springfield, IL 62756 Telephone (217) 782-9520 http://www.cyberdriveillinois.com

APPLICATION FOR RESERVATION OF NAME
Under the General Not For Profit Corporation Act

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SUBMIT ONE ORIGINAL
This space for use by Secretary of State Date Filing Fee Approved: $

Remit payment in check or money order, payable to "Secretary of State." Filing fee is $25 for each name reserved.

Pursuant to the provisions of "The General Not For Profit Corporation Act of 1986," the undersigned hereby submits the following Application for Reservation of Name. 1. The following name or names shall be reserved for a period of 90 days each:
(May contain the word "corporation", "incorporated", or "limited", or may contain an abbreviation of one such word)

2.

A brief summary of the purpose intended to be conducted by the corporation is:

3. 4.

Name applicant Address of applicant

Dated

(Month & Day)

,

(Year) Signature of Applicant

NOTE: If the applicant is an individual, it is to be signed by the applicant. If the applicant is a corporation, it is to be signed by the corporation's president or vice-president and verified by him and attested to by the secretary or an assistant secretary.

NOTICE OF TRANSFER OF RESERVED NAME

Date Filing Fee Approved $25

The undersigned to name in Illinois. This name was reserved on

(Name of Original Applicant) (Name of Transferee)

hereby transfers the right to use the for corporate purposes , .

(Month & Day)

(Year)

The undersigned affirms, under penalties of perjury, that the facts stated herein are true. Dated
(Month & Day)

,
(Year)

. By
(Signature of Original Applicant)

Attested by:
(Type or Print Name) If a corporation, by its president or vice president*

* As the original applicant, I declare that this document has been examined by me and is to the best of my knowledge and belief, true, correct and complete.

C-140.10