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Wyoming Secretary of State

State Capitol Building, Room 110 th 200 West 24 Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: Business@wyo.gov

For Office Use Only

Limited Liability Company Application for Reservation of Name

Pursuant to W.S. 17-15-105(d), and according to the rules promulgated by the Secretary of State of Wyoming, a person may reserve a name for a limited liability company for a one hundred twenty (120) day period, by delivering an application to the Secretary of State for filing.

1. Name of applicant:

2. Address of applicant:

3. Proposed name to be reserved:


Signature: ___________________________________________
(Shall be executed by a member, manager, or other authorized individual as set forth in the operating agreement.)

Print Name: Title: Contact Person: Daytime Phone Number: Checklist Filing Fee: $50.00 Make check or money order payable to Wyoming Secretary of State. Please submit one originally signed document and one exact photocopy of the filing. Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in the processing of your documents.

LLC-NameReservation - Revised 12/11