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 Consent or Release
USE BLACK INK ONLY - DO NOT HIGHLIGHT ABOVE SPACE IS FOR OFFICE USE ONLY

Name Consent (if name is currently filed in Nevada)
I,
current holder of name

, hereby give consent to use the name
recipient of name consent

to

name being released for use by the recipient

Name Reservation Release (if name is currently reserved in Nevada)
I,
current holder of reserved name

, hereby give consent to use the name
person to whom reserved name is being released

to

reserved name being released

Signed: X
signature of current holder of name

(document must be signed before a notary public)

State of County of This document was acknowledged before me on
date

By
name of person being notarized signature of notary public

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Nevada Secretary of State Name Consent Release Revised: 4-10-09