Conduct of Business Under Fictitious or Assumed Name : Please fill out the following form. Please print your completed form if you would to have a copy for your records.
State of :
Pursuant to (Enter the applicable state statue or code) relating to the conduct of business under (Enter either Fictitious or Assumed) name, the undersigned (Enter the name of the person signing this form) hereby present(s) for filing the following application in the office of (Enter the name of the state office where this form will be sent).
1. The (Enter either Fictitious or Assumed) name under which the business is, or will be, carried on is (Enter the name of business).
2. 2. The real name and address of each person owning or interested in the business is (Enter the name and address of the interested party).
3. The nature of the business is (Enter the description of the business purpose).
4. The business will be conducted at (Enter the address of business).
STATE OF :
COUNTY OF :
On _________________________ before me ________________________ personally appeared ___________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Affiant : Known / Unknown
ID Produced :
Affidavits Forms Index
Conduct of Business Under Fictitious or Assumed Name
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