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Application for Fictitious Name

Pursuant to the provisions of the Arkansas Business Corporation Act (Act 958 of 1987), the undersigned corporation 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 corporation is:
2. The character of the business being, or to be, conducted under such fictitious name is:
3. a. The corporation name of the applicant and its date of qualification in Arkansas:
/ / (mm/dd/yyyy)
b. The State of incorporation is:
c. The location (city and street address) of the registered office
of the applicant corporation in Arkansas is:
Street Address:
Signature of the Chairman of the Board, President or other
officers (if directors have not been selected, the incorporator may execute):
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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