APPLICATION TO RESERVE A LIMITED LIABILITY COMPANY NAME Pursuant to Section ______________________ of the Statutes of the State of ______________________, the undersigned hereby applies to the Secretary of State to reserve the following limited liability company name: 1. The limited liability company name to be reserved is ______________________ ____________________________________________________________ (Name). 2. The name of the applicant is: ____________________________________(Name). 3. The address of the applicant is: ___________________________________________________ (Address) ___________________________________________________ (City, State, Zip Code) 4. The above limited liability company name is to be reserved for a nonrenewable period of 120 days (or such other period as is permitted by statute) from the date of the filing of this application. This the ____________ day of ___________________ (month), ______ (year). __________________________________________________ (Signature) __________________________________________________ (Name and Title)