APPLICATION FOR
Secretary of State Office
500 E Capitol Ave
RESERVATION OF NAME
Pierre, SD 57501
(605)773-4845
Clear Form
BUSINESS CORPORATION
Please Type or Print Clearly in Ink
HELP
Original
Photocopy
Please submit one
and one
FILING FEE: $25
SECRETARY OF STATE
payable to
Telephone # ____________________
FAX #
_______________________
Pursuant to the provisions of the South Dakota Law, the undersigned hereby applies for reservation of the
following name for a period of one hundred twenty (120) days, which period shall not be extended.
1. The name to be reserved is _______________________________________________________________________
______________________________________________________________________________________________
Note: The name must include the term corporation, incorporated, company, limited or the applicable abbreviation.
2. Check one to indicate how the reserved name is to be used:
Incorporation of a domestic business
Domestic corporation intending to change its name
Foreign corporation intending to make application for a Certificate of Authority
Foreign corporation authorized in this state intending to change its name
Any person intending to organize a foreign corporation and to have such corporation make application for
a Certificate of Authority
Dated ____________________________
______________________________________________
(Signature of the applicant)
______________________________________________
(Printed Name)
______________________________________________
(Title)
______________________________________________
(Address)
______________________________________________
(City)
(State)
(ZIP+4)
reservationofname April 2012