Fill and Sign the Form 811 Download Fillable PDF Certificate of

oFiling fee The �ling fee for this form is $35. o Payment Please enclose a check or money order payable to the Secretary of State. Forms received without the appropriate fee will not be accepted for �ling. Please do not send cash. NOTICE: There is a $25 service fee for all checks returned by your �nancial institution. Also, to expedite processing, please do not use staples on your documents or to attach checks. o Reservation The name reservation is effective for 120 days. This is not a name registration. It is a method to temporarily reserve an entity name until your are ready to �le a formation document for the entity. o Renewal Name reservations may not be renewed. If a reservation is submitted prior to the expiration of a current name reservation, the new reservation will be rejected. o Transfer right The original applicant may transfer the right to a reserved name by �ling a written notice of such transfer. The notice should include the name and address of the transferee (new applicant). k a n s a s s e c r e ta ry o f s tat e Temporary Reservation of Business Entity NameInstructions Kansas Of�ce of the Secretary of State: Memorial Hall, 1st Floor (785) 296-4564 120 S.W. 10th Avenue kssos@sos.ks.gov Topeka, KS 66612-1594 www.sos.ks.gov NR 52-01 The following form must be complete and accompanied by the correct filing fee or the document will not be accepted for filing. Inst. K.S.A. 17-7402 Rev. 6/2/15 tc Please proceed to form. Save time and money by filing your forms online at www.sos.ks.gov . There, you can also stay up-to-date on your organization’s status, annual report due date, and contact addresses. This form must be complete and accompanied by the correct �ling fee or the document will not be accepted for �ling.1. The undersigned reserves the following entity name Entity name to be reserved 2. Name of applicant 3. Address of the applicant Address City State Zip Code Country Signature of Applicant X Month Day Year Name of Signer (Printed or Typed) TitlePhone Number 1 / 1 K.S.A. 17-7402 Rev. 6/2/15 tc k a n s a s s e c r e ta ry o f s tat e Temporary Reservation of Business Entity Name Kansas Of�ce of the Secretary of State: Memorial Hall, 1st Floor (785) 296-4564 120 S.W. 10th Avenue kssos@sos.ks.gov Topeka, KS 66612-1594 www.sos.ks.gov NR 52-01 THIS SPACE FOR OFFICE USE ONLY. Please review to ensure completion.