STATE OF NORTH CAROLINA
DEPARTMENT OF THE SECRETARY OF STATE
APPLICATION TO RESERVE A BUSINESS ENTITY NAME
Pursuant to §55D-23(c) of the General Statutes of North Carolina, the undersigned hereby applies to the Secretary of State to reserve
the following entity name:
The entity name to be reserved is: ________________________________________________________________________
Domestic Nonprofit Corporation,
Foreign Nonprofit Corporation,
Domestic Limited Liability Company,
Foreign Limited Liability Company,
Domestic Limited Partnership,
Foreign Limited Partnership,
Domestic Limited Liability Partnership,
Foreign Limited Liability Partnership.
The name of the applicant is: ______________________________________________________________________________
The address of the applicant is:
Street Address __________________________________________________________________________________________
City, State, Zip Code _____________________________________________________________________________________
The applicant has acquired the goodwill of a domestic or foreign corporation, domestic or foreign limited liability company, a
domestic or foreign limited partnership, or a domestic or foreign registered limited liability partnership authorized to transact
business in the State of North Carolina. (Satisfactory evidence of the acquisition of the goodwill of such entity must be
furnished to the Secretary of State along with this Application.)
The name of the entity whose goodwill was acquired is:__________________________________________________
State of incorporation or formation: _________________________________________________________________
The above entity name is to be reserved for a period of 10 years from the date of the filing of this application.
This the _______ day of __________________, 20______.
Name of Entity
Type or Print Name and Title
Filing fee is $10. This document must be filed with the Secretary of State.
This form may only be used by a person that has acquired the goodwill of a domestic or foreign entity authorized to transact business
or conduct affairs in the State of North Carolina.
P. O. BOX 29622
RALEIGH, NC 27626-0622
(Revised January 2002)