Request For Reservation Of Name - Minnesota Secretary Of State
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MINNESOTA SECRETARY OF STATE
REQUEST FOR RESERVATION OF NAME
I hereby request the Secretary of State to reserve the name listed below. I understand that the name reservation does
not register the business name, and is valid for twelve months from the date on which it is filed. The name reservation
may be renewed for additional twelve month periods, pursuant to MN Statutes, 302A.117, 317A.117, 322B.125 or 321.109.
READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
Filing Fee: $35.00
1. Desired Name: (Required) ______________________________________________________________________
2 Reserved For: (Required) _______________________________________________________________________
Note: If this name is reserved for an organization not yet formed, list the individual who will be signing the documents,
which will be submitted at the time of the organization of the business.
3. Located at: (Required) _________________________________________________________________________
(Street
Address)
__________________________________________________________________________
(City)
(State)
(Zip)
4. The applicant hereby states that the proposed name holder is:
a. A person doing business in this state under that name or a deceptively similar name;
b. A person intending to form an entity under Chapter 302A, 317A, 322B or 321;
c. A domestic corporation, limited liability company or limited partnership intending to change its name;
d. A foreign corporation, foreign limited liability company or foreign limited partnership intending to make application
for a Certificate of Authority to transact business or register in this state;
e. A foreign corporation, foreign limited liability or foreign limited partnership authorized to transact business in this
state and intending to change its name;
f.
A person intending to incorporate a foreign corporation, or foreign limited liability company and intending to have
the foreign corporation, or foreign limited liability company make application for a Certificate of Authority to
transact business in this state; a person registering as a foreign limited partnership; or
g. A foreign corporation, foreign limited liability company or foreign limited partnership doing business under that
name or a name deceptively similar to that name in a state other than Minnesota and not described in clauses d, e or f.
I, the undersigned, certify that I am signing this document as the person whose signature is required, or as agent of the person(s) whose
I certify that the foregoing is true and accurate and that I have the authority to sign this document on behalf of the
signature would be required who has authorized me to sign this document on his/her behalf, or in both capacities. I further certify that
proposed name holder, and I further certify that I understand that by signing this reservation, I am subject to the penalties
I have completed all required fields, and that the information in this document is true and correct and in compliance with the applicable
of perjury as set forth in section 609.48 as if I had signed this reservation under oath.
chapter of Minnesota Statutes. I understand that by signing this document I am subject to the penalties of perjury as set forth in
Section 609.48 as if I had signed this document under oath.
5. Signature: (Required) __________________________________Position: ___________________________________
Name, daytime telephone number and e-mail address of contact person:
6.
Name: __________________________________Phone:(___)______________________Ext. ________
E-Mail Address: ______________________________________________________________________
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