Form Sfn 13015 - Reserve Name Application - North Dakota Secretary Of State

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FOR OFFICE USE ONLY

RESERVE NAME APPLICATION

ID Number

SECRETARY OF STATE

SFN 13015 (03-2012)

WO Number

Filed

To Expire

NOTE: The filing of the Reserve Name Application does not establish a North Dakota entity nor does

it grant authority to a foreign (out-of-state) entity to transact business in the State of North Dakota.

TWELVE MONTH DURATION

It merely reserves the name until the entity is able to complete and file the required documents.

(Renewable for successive

twelve month periods.)

1. FILING FEE: $10.00

SEE PAGE 2 FOR FEES, FILING AND MAILING INSTRUCTIONS

2. The undersigned hereby applies for the reservation of a name for a period of twelve months for the purpose of filing one of the following:

(check one)

Domestic

Foreign

(Organized under

(Organized under laws other than

North Dakota laws)

North Dakota's)

Cooperative Association

- - - - - - - - - - - - - - - - - - - - - - - - -

Corporation:

General Business

- - - - - - - - - - - - - - - - - - - - - - - - -

Farm

- - - - - - - - - - - - - - - - - - - - - - - - -

Nonprofit

- - - - - - - - - - - - - - - - - - - - - - - - -

Professional

- - - - - - - - - - - - - - - - - - - - - - - - -

Limited Liability Company:

General Business

- - - - - - - - - - - - - - - - - - - - - - - - -

Farm

- - - - - - - - - - - - - - - - - - - - - - - - -

Nonprofit

- - - - - - - - - - - - - - - - - - - - - - - - -

Professional

- - - - - - - - - - - - - - - - - - - - - - - - -

Limited Liability Partnership

General Business

- - - - - - - - - - - - - - - - - - - - - - - - -

Professional

- - - - - - - - - - - - - - - - - - - - - - - - -

Limited Partnership

- - - - - - - - - - - - - - - - - - - - - - - - -

Limited Liability Limited Partnership

- - - - - - - - - - - - - - - - - - - - - - - - -

A foreign corporation or foreign limited liability company may not engage in farming or ranching in North

Dakota. A limited liability partnership, a limited partnership, or a limited liability limited partnership may engage

in farming or ranching only if the partners are all individuals or organizations created under North Dakota's

Corporate or Limited Liability Company Farming Act, N.D.C.C., Chapter 10-06.1.

3. Name to be Reserved

4. Name of Owner of the Reserved Name

5. Telephone Number of Owner

6. Address of Owner of Name to be Reserved (Street/RR, PO Box, City, State, ZIP+4)

7. "The undersigned owner, knows the contents of this application and believes the statements provided are correct. I understand that if I make a false

statement in this document, I may be subject to criminal penalties."

Signature

Date

8. Name of Person to Contact About This Document

9. E-Mail Address

10. Telephone Number of Filer and Extension,

if any