Fill and Sign the Pursuant to the Laws of the State of New Jersey the Undersigned Applicant Hereby Applies for the Form

UNRR-1 Rev. 5/03 New Jersey Division of Revenue Application for Reservation of Name Pursuant to the laws of the State of New Jersey, the undersigned applicant hereby applies for the reservation of a business name for (check one): __ For-Profit Corporation (Title 14A) __ Non-Profit Corporation (Title 15A) __ Limited Partnership (Title 42:2A) __ Limited Liability Company (Title 42:2B) __ L im ited Liability Pa rtne rs h ip (Title 4 2:1) The business name to be reserved is: OR, The business name to be reserved is the first available name among the three names below: 1) 2) 3) Applicant's Address Street: City: State: Zip: Applicant's Name (type): Applicant's Title: Applicant's Signature: Date: This reservat ion will be effective for 120 da ys subse quent to acceptance and fili ng in the State Treasure r's Office, and may be renewed, transferred or canceled. The person who signs this document will have NJ D iv ision of Re ven u e, PO B ox 30 8, T re n to n, NJ 0 86 46 ownership of the reserved name. Rev 2/1/06 Instructions for Form UNRR-1 APPLICATION FOR RESERVATION OF NAME STATUTORY FEE: See Below The MANDATORY fields are: Business Type Choose the business type/statutory au thority under which you are filing: $50 For-Profit Corporation (Title 14A) $50 Non-Profit Corporation (Title 15A) $50 Limited Partnership (Title 42:2A) $50 Limited Liability Company (Title 42:2B) $50 Limited Liability Partnership (Title 42:1) Name List the business name to be reserved. Provide up to three names with the first available to be reserved. **The name must be distinguishable from other names on the State’s database. The Division of Revenue will check the proposed name for availability as part of the filing review process. Applicant’s Address List the applicant’s address. Applicant’s Name List the name of the person for whom the business name is being reserved. Applicant’s Title List the applicant’s title. EXECUTION (Applicant’s Signature/Date) The applicant must sign and date the application. Once the application is accepted and filed in the State Treasurer’s Office, the applicant will obtain ownership of the reserved name. If someone other than the applicant is preparing this document, make sure that the applicant’ s information and signature are provided. ********** These documents should be filed in duplicate. Non-profits should file in triplicate. Make checks payable to: TREASURER, STATE OF NEW JERSEY. (No cash, please) Mail to: NJ Division of Revenue, PO Box 308, Trenton, NJ 08646 FAX File: 6 09.9 84.68 51 (Fax Filing is an o p ti on al ex ped ited ser vice subject to pr ocess in g fees t hat are in add ition to those stated a b ov e. F or FAX Fi li n g i n fo rm ati on , v isit http://www.state.nj.us/treasury/revenue/dcr/programs/ffs.html . )