$25.00 Filing Fee payable to Arkansas Secretary of State
RN-06/ Rev. 11/18
Application for Reservation of Entity Name
Instructions: Mail to Secretary of State’s Business and Commercial Services Division, 1401 W. Capitol, Suite 250, Little
Rock, Arkansas 72201. A file stamped copy, noting expiration date will be returned for your files.
The owners of a reserved name may transfer the reservation to another person by delivering to the Secretary of State a signed
notice of the transfer that states the name and address of the transferee.
The transfer shall be effective for the duration of the reservation.
J
urisdiction (S
elect One)
Domestic
Foreign
The undersigned, pursuant to the provisions of the appropriate Act listed above, hereby requests that the following name be
reserved for a 120 day period.
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Address City State, Zip
I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C
misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.
Witness the hand and seal of the applicant executed under oath, on this the ______ day of ____________, ______________.
______________________________________________________ _______________________________________________
Typed or Printed Name of Applicant
Signature of Applicant
Name To Be Reserved
Entity Type (Select One)
For-Profit Corporation (Act 958 of 1987 or A.C.A § 4-27-402 non-renewable)
Nonprofit Corporation (Act 1147 of 1993 or A.C.A § 4-33-402 non-renewable)
LLC
(Act 104 of 1993 or A.C.A § 4-32-104 with 1 renewal in 120 days)
Arkansas Secretary of State
John Thurston
1401 W. Capitol, Suite 250,
501-682-3409 • www.sos.arkansas.gov
Little Rock, AR 72201
