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ATTN: To ensure that your payment is processed in a timely manner, please confirm that the following originator id for ACH Debit 1522077581 is on file with your bank.

Application for Fictitious Name

for a Limited Liability Partnership

Pursuant to the provisions of Act 1528 of 1999, the undersigned limited liability partnership hereby applies for the use of a fictitious name and submits herewith the following statement:

1. The fictitious name under which the business is being, or will be, conducted by this limited liability partnership is:
2. The character of the business being, or to be, conducted under such fictitious name is:
3. a) The limited liability partnership's name and its date of qualification in Arkansas:
/ / (mm/dd/yyyy)
b) The State of registration is:
c) The location (city and street address) of the registered office
of the applicant limited liability partnership in Arkansas is:
Street Address:
Signature (The partner acknowledges that he/she is authorized to execute this application):
Street Address:
2 Letter Abbreviation 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.

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