Fill and Sign the Fillable Online Release Notes 021805doc Fax Email Print Form

$25.00 Filing Fee payable to Arkansas Secretary of State RN-06/ Rev. 11/18 Application for Reservation of Entity Name Instructions: Mail to Secretary of State’s Business and Commercial Se rvices Division, 1401 W. Capitol, Suite 250 , Little Rock, Arkansas 72201. A file stamped copy, noting expirati on date will be returned for your files. The owners of a reserved name may transfer the reservation to another person by delivering to the Secretary of State a signed notice of the transfer that st ates the name and address of the transferee. The transfer shall be effective fo r the duration of the reservation. Jurisdiction (S elect One) Domestic Foreign The undersigned, pursuant to the provisions of the appropriate Act listed ab ove, hereby requests that the following name be reserved for a 120 day period. ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Address City Stat e , Zip I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C mis demeanor and is punishable b y a fine up to $100.00 and/or imp risonment up to 30 days. Witness the hand and seal of the applicant executed under oath, on this the ______ day of __ __________, ______________. ______________________________________________________ _______________________________________________ Typed or Printed Name of Applicant Signature of Applicant Name To Be Reserved Entity Type (Select One) For-Profit Corporation ( Act 958 of 1987 or A.C.A § 4-27-402 non-renewable) Nonprofit Corporation (Act 1147 of 1993 or A.C.A § 4-33-402 non-renewable) LLC (Act 104 of 1993 or A.C.A § 4-32-104 with 1 renewal in 120 days) Ark an sa s S e cre ta ry o f S ta te John Thurston 1401 W. Capitol, Suite 250, 501-682-3409 • www.sos.arkansas.gov Little Rock , AR 72201