F0016 - Page 1 of 1

OFFICE OF THE MISSISSIPPI SECRETARY OF STATE

P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1333

*0016-1-1*
1. Type of Corporation (X in one only)
Mississippi Profit

Reservation of Name

Mississippi Nonprofit

Mississippi Limited Partnership

Foreign Limited Partnership

Foreign Profit

Foreign Nonprofit

2. Name to reserve

3. (For Foreign Corporations and Limited Partnerships ONLY) - Name elected to use in Mississippi

4. Applicants name and address

Address City, State, ZIP5, ZIP4 Signature of Owner/ Applicant

(Please keep writing within blocks)

Rev. 01/96