Free Form - Nevada

ROSS MILLER Secretary of State 204 North Carson Street, Suite 4 Carson City, Nevada 89701-4520 (775) 684 5708 Website: www.nvsos.gov

Name Reservation Request

USE BLACK INK ONLY - DO NOT HIGHLIGHT

ABOVE SPACE IS FOR OFFICE USE ONLY

I,

, hereby request that the name

be reserved for the period of 90 days. Holder of Reservation:
Name Address City State Zip (choose only one)

Confirmation of Reservation:

Mail to holder of reservation at the above address. Email to the following address: See other instructions below:

Notes:

FILING FEE: $25.00
This form must be accompanied by appropriate fee.

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Nevada Secretary of State Name Reservation Revised: 4-10-09