APPLICATION FOR
RESERVATION OF CORPORATE NAME
John A. Gale, Secretary of State
Room 1301 State Capitol, P.O. Box 94608
Lincoln, NE 68509
http://www.sos.state.ne.us
Submit in Duplicate
The undersigned hereby requests that the following name be reserved.
Name to be Reserved_____________________________________________________
Reservation is good for 120 days and is not renewable.
DATED__________________________ ________________________________
Signature
________________________________
Printed Name/Title
________________________________
Street Address
________________________________
City, State, Zip
NOTE: Every filing must be signed by the chairperson of the board of directors, the president, or one of the officers
of the corporation. If the corporation has not yet been formed or directors have not yet been selected, the filing
shall be signed by an incorporator. If the corporation is in the hands of a receiver, trustee, or other court appointed
fiduciary, the filing shall be signed by that fiduciary.
FILING FEE: $30.00
Revised 12/19/2000 Neb. Rev. Stat. 21-1932 & 21-2029