F0016 - Page 1 of 1
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1333
*0016-1-1*
1. Type of Corporation (`X' in one only)
Mississippi Profit
Reservation of Name
Mississippi Nonprofit
Mississippi Limited Partnership
Foreign Limited Partnership
Foreign Profit
Foreign Nonprofit
2. Name to reserve
3. (For Foreign Corporations and Limited Partnerships ONLY) - Name elected to use in Mississippi
4. Applicant's name and address
Address City, State, ZIP5, ZIP4 Signature of Owner/ Applicant
(Please keep writing within blocks)
Rev. 01/96