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E payable to Secretary of State Do Not Send Cash Return to: Commercial Division P. O. Box 94125 Baton Rouge, LA 70804-9125 Phone (225) 925-4704 Web Site: www.sos.louisiana.gov STATE OF PARISH/COUNTY OF Check One: ( ) Trade Name ( ) Trademark Check One: ( ) Service Mark ( ) Original Filing ( ) Renewal 1. Name of person(s), Corporation, Limited Liability Company or Partnership applying for registration: 2. If applicant is a corporation, list state of incorporation: 3. Full street address.

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