Form L001.001 - Application To Reserve Limited Liability Company Name - 2010

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DO NOT WRITE ABOVE THIS LINE; RESERVED FOR ACC USE ONLY.

APPLICATION TO RESERVE LIMITED LIABILITY COMPANY NAME

Read the Instructions

L001i

NAME TO BE RESERVED –

see Instructions L001i

for name requirements for different entity

types. Enter the exact name or exact fictitious name to be reserved:

_______________________________________________________________________

TYPE OF ENTITY – check only one to indicate the type of entity that may be formed:

LIMITED LIABILITY COMPANY

PROFESSIONAL LIMITED LIABILITY COMPANY

APPLICANT – name and address of the individual or entity that will own the name reservation:

Name

Address 1

Address 2 (optional)

City

State or Province

Zip

Country

SIGNATURE:

By checking the box marked "I accept" below, I acknowledge under penalty of perjury

that this document together with any attachments is submitted in compliance with

Arizona law.

I ACCEPT

Signature

Printed Name

Date (mm/dd/yyyy)

REQUIRED – check only one:

I am the Applicant (I am an individual or

The Applicant is an entity and I am its duly

natural person and not an entity).

authorized agent.

Mail:

Arizona Corporation Commission

Filing Fee: $10.00 (regular processing)

Corporate Filings Section

Expedited processing – add $35.00 to filing fee.

1300 W. Washington St., Phoenix, Arizona 85007

All fees are nonrefundable - see Instructions.

Fax:

602-542-4100

Please be advised that A.C.C. forms reflect only the minimum provisions required by statute. You should seek private legal counsel for those matters that may pertain

to the individual needs of your business.

All documents filed with the Arizona Corporation Commission are public record and are open for public inspection.

If you have questions after reading the Instructions, please call 602-542-3026 or (within Arizona only) 800-345-5819.

L001.001

Arizona Corporation Commission – Corporations Division

Rev: 2010

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