Application For Exclusive Right To Name Of A Business Trust Form

Application For Exclusive Right To Name Of A Business Trust Form - State Of Ohio

J. Kenneth Blackwell

Prescribed by

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APPLICATION FOR EXCLUSIVE RIGHT TO NAME

OF A BUSINESS TRUST

(may be filed by Ohio business trusts which have not made the filing described under section 1746.04 of the Ohio Revised Code)

The Applicant, a business trust NOT having made the filings described under section 1746.04 of the Ohio Revised Code, hereby

declares that:

The exact name to be registered is:

The complete Ohio address of the principal office of the business trust is:

The date, if any, upon which the business trust began engaging in business in Ohio is:

(date)

The general nature of the business in which the business trust is engaged is:

The period of existence of the business trust, as stated in the trust instrument, expires on:

(date)

The applicant business trust agrees to file in the office of the Secretary of State a written transfer stating the name and

address of the transferee, if it transfers the right to the exclusive use of the name applied for above.

The undersigned, being first duly sworn, state that I am a trustee of the applicant and verify that the above declarations are true

to the best of my knowledge and belief.

Signature:

Name:

(trustee)

Sworn to before me and subscribed in my presence

(date)

Signature:

Name:

(notary public)

(SEAL)

Expiration Date:

(date)

118-BTN

Page 1 of 1

Version: July 15, 1999

Application For Exclusive Right To Name Of A Business Trust Form - State Of Ohio