STATE OF NORTH CAROLINA DEPARTMENT OF THE SECRETARY OF STATE
NOTICE OF TRANSFER OF RESERVED ENTITY NAME
Pursuant to §55D-23 of the General Statutes of North Carolina, notice is hereby given that the undersigned has transferred the following reserved business entity name. 1. 2. The reserved entity name is:____________________________________________________________________________ The reserved entity name is hereby transferred to:___________________________________________________________ Name______________________________________________________________________________________________ Address____________________________________________________________________________________________ City, State, Zip Code__________________________________________________________________________________ 3. The date of filing of the original application to reserve this entity name was:______________________________________
This the______day of ________________________, 20_____ _________________________________________________________
Name of Original Applicant/Transferor _______________________________________________________________ Signature _______________________________________________________________ Type or Print Name and Title
NOTES: 1. Filing fee is $10. One executed original must be filed with the Secretary of State.
CORPORATIONS DIVISION
(Revised January 2002)
P. O. BOX 29622
RALEIGH, NC 27626-0622
(Form BE-04)
NOTICE OF TRANSFER OF RESERVED ENTITY NAME Instructions for Filing Item 1 Item 2 Item 3 Enter the complete name exactly as it appears on the reservation. Enter the name and complete address of the person to whom the reserved name is being transferred. Enter the date the original reservation was filed. Date and Execution Enter the date the document was executed. In the blanks provided enter: ♦ The name of the entity or individual that is the transferor or owner of the reserved name. ♦ The signature of the transferor or of the representative of the entity transferring the name. ♦ The name and title of the above-signed representative (only if an entity is the transferor).
CORPORATIONS DIVISION
(Revised January 2002)
P. O. BOX 29622
RALEIGH, NC 27626-0622
(Form BE-04)