Free Form - Nevada

ROSS MILLER Secretary of State 202 North Carson Street Carson City, Nevada 89701-4201 (775) 684 5708 Website: www.nvsos.gov

Application for Reinstatement

USE BLACK INK ONLY - DO NOT HIGHLIGHT

ABOVE SPACE IS FOR OFFICE USE ONLY

Important: form for use ONLY if old name is unavailable.
This application authorizes the office of the Secretary of State of Nevada to reinstate:

Old Name

under the name of:

New Name

This application is accompanied with the initial or annual list, the designation of the registered agent, and all fees and penalties.

X
Authorized Signature*

* If a corporation, this application shall be signed by an officer. If a limited-liability partnership, this application shall be signed by a managing partner. If a limited-liability company, this application shall be signed by a manager or managing member. If a limited partnership, this application shall be signed by a general partner.
Nevada Secretary of State Application for Reinstatement Revised: 4-23-09

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