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APPLICATION FOR

RESERVATION OF NAME

FOR DOMESTIC OR FOREIGN STOCK &

NONSTOCK CORP, LLC, LP, LLP & STATUTORY TRUST

C.G.S. §§ 33-655; 33-656; 33-925; 33-1045; 33-1046; 33-1215; 34-13 ; 34-13a; 34-38i;

34-102; 34-103;34-227; 34-406; 34-407; 34-506; 34-535

USE INK. COMPLETE ALL SECTIONS. PRINT OR TYPE. ATTACH 81/2 X 11 SHEET(S ) IF NECESSARY.

ADDRESS:

CITY:

STATE:ZIP:

FILING PARTY (CONFIRMATION WILL BE SENT TO THIS ADDRESS): NAME:

FILING FEE: $60

MAKE CHECKS PAYABLE TO "SECRETARY

OF THE STATE"

THE UNDERSIGNED HEREBY APPLIES FOR RESERVATION OF THE FOLLOWING NAME:

1. NAME TO BE RESERVED -

REQUIRED:

(MUST INCLUDE APPROPRIATE BUSINESS DESIGNATION I.E., L.L.C., INC, ETC.)

2. NAME OF THE APPLICANT - REQUIRED:

ADDRESS:

CITY:

STATE:ZIP:

3. ADDRESS OF APPLICANT: (COMPLETE ADDRESS REQUIRED. STREET NAME, CITY, STATE & ZIP CODE.)

4. EXECUTION - REQUIRED: (SUBJECT TO PENALTY OF FALSE STATEMENT)

DATED THIS DAY OF , 20

NAME OF APPLICANT

(print/type)CAPACITY/TITLE OF APPLICANT (print name and title if applicable)

SIGNATURE

THE RESERVATION WILL BE EFFECTIVE FOR A PERIOD OF 120 DAYS FROM FILE DAT

E. FILE DATE IS DAY

ONE. AT THE END OF THE 12OTH DAY, THE NAME RESERVATION EXPIRES

PAGE 1 OF 1

FORM CNR-1-1.0

Rev. 11/2012

SECRETARY OF THE STATE OF CONNECTICUT

MAILING ADDRESS:

COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, P.O.

BOX 150470, HARTFORD, CT 06115-0470

DELIVERY ADDRESS:

COMMERCIAL RECORDING DIVISION, CONNECTICUT SECRETARY OF THE STATE, 30 T

RINITY STREET, HARTFORD, CT 06106

PHONE:

860-509-6003 WEBSITE: www.concord-sots.ct.gov

APPLICATION FOR RESERVATION OF NAME

For Domestic or Foreign Stock & Non-Stock Corp, LLC, LP, LLP & Statutory Trust C.G.S. §§ 33-655; 33-656; 33-925; 33-1045; 33-1046; 33-1215; 34-13 ; 34-13a;34-38i;34-102; 34-103;34-227; 34-406;

34-407; 34-506; 34-535

FILING FEE: $60.00

Make checks payable to "Secretary of the State"

INSTRUCTIONS

1. NAME: Please provide the name which you intend to reserve. You may re

serve for exclusive use the name of one of the following types of business organizations or entities: A corporation (stock & non-stock), limited liability company, limited partnership, limited liability partnership or statutory trust. T he name which you reserve must contain the appropriate statutory designation which denotes the type of entity or or ganization for which the name is intended to be used. Choose a statutory designation from the selection below according to organization type and include it within the name as it appears in block 1 on the form.

CORPORATE DESIGNATIONS

The name of a corporation must contain one of the following designations : corporation, incorporated, company,

Societa

per Azioni, limited or the abbreviations corp., inc., co., S.p.A. or ltd

LIMITED LIABILITY COMPANY DESIGNATIONS

The name of a limited liability company must contain one of the followin g designations: Limited Liability Company, L.L.C., LLC, Limited Liability Co., Ltd. Liability Company or Ltd. Liability Co.

LIMITED PARTNERSHIP DESIGNATIONS

The name of a Limited Partnership must contain, without abbreviation; th e words limited partnership.

LIMITED LIABILITY PARTNERSHIP DESIGNATIONS

The name of a limited liability partnership must contain one of the foll owing designations: Registered Limited Liability Partnership, Limited Liability Partnership, L.L.P., or LLP as its last w ords or letters.

STATUTORY TRUST DESIGNATION

The name of a statutory trust must contain one of the following designat ions: Statutory Trust, Limited Liability Trust,

Limited, LLT, L.L.T., or Ltd.

2. NAME OF APPLICANT: Please print or type the name of the applicant.

3. ADDRESS OF APPLICANT: Please provide the street address of the applic

ant including street number, street name, city, state and postal code.

4. EXECUTION: Please print or type the complete legal name of the signat

ory, title (if signing on behalf of an entity) and signature. Note that the execution constitutes a statement made under th e penalties of false statement that the information provided in the document is true.

OFFICE OF THE SECRETARY OF THE STATE

MAILING ADDRESS:

COMMERCIAL RECORDING DIVISION

CONNECTICUT SECRETARY OF THE STATE

P.O. BOX 150470

HARTFORD, CT 06115-0470

DELIVERY ADDRESS:

COMMERCIAL RECORDING DIVISION

CONNECTICUT SECRETARY OF THE STATE

30 TRINITY STREET

HARTFORD, CT 06106

PHONE:

860-509-6003

WEBSITE: www.concord-sots.ct.gov

INSTRUCTIONS

FORM CNR-1-1.0

Rev. 11/2012

DO NOT SCAN THIS PAGE

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